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Hașegan A, Mihai I, Teodoru CA, Matacuta IB, Dura H, Todor SB, Ichim C, Tanasescu D, Grigore N, Bolca CN, Mohor CI, Mohor CI, Bacalbașa N, Bratu DG, Boicean A. Exploring the Challenges of Using Minimal Invasive Surgery to Treat Stress Urinary Incontinence: Insights from a Retrospective Case-Control Study. Diagnostics (Basel) 2024; 14:323. [PMID: 38337839 PMCID: PMC10855614 DOI: 10.3390/diagnostics14030323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105-1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case.
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Affiliation(s)
- Adrian Hașegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Ionela Mihai
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Cosmin Adrian Teodoru
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Ioana Bogdan Matacuta
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Horațiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Denisa Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Nicolae Grigore
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | | | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Călin Ilie Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Nicolae Bacalbașa
- Surgery Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
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Shebl SE. Two-year outcomes of surgeon-tailored trans obturator tape for female stress urinary incontinence: a randomized, comparative, trial with traditional trans obturator tape. BMC Urol 2021; 21:155. [PMID: 34772395 PMCID: PMC8590356 DOI: 10.1186/s12894-021-00922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Previously, we presented the short-term outcomes of surgeon-tailored mesh in patients with SUI undergoing TOT. In this report, we aim to highlight the two-year outcomes of surgeon tailored mesh in terms of subjective and objective cure rates, as well as late complications. Methods We performed a randomized, open-label comparative trial that recruited women with SUI who were scheduled to undergo TOT. Eligible patients were randomly allocated in a 1:1 ratio to receive traditional TOT mesh or surgeon-tailored polyethylene mesh. All patients were followed up for two years. Results At the end of the follow-up, there were 13 women in the traditional TOT mesh group and 14 patients in the surgeon-tailored polyethylene mesh group. Concerning the primary outcome of the present study, the cure rate was 100% in the surgeon-tailored polyethylene mesh (n = 14) and 92.9% in the traditional TOT mesh group (p = 0.39). One woman reported improved symptoms in the traditional TOT mesh group. There were no reported failures in both groups. Concerning safety, the incidence of de novo urgency was 0% in the surgeon-tailored polyethylene mesh group, compared to 7.1% in the traditional TOT mesh group (p = 0.34). None of the women in both groups reported mesh erosions, dyspareunia, or need for reoperation. Conclusion Surgeon-tailored mesh for patients undergoing TOT is a cost-effective technique, which has comparable long-term outcomes, in terms of cure rate and complications, to the traditional costly meshes. Larger multicentre studies should confirm our results.
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Affiliation(s)
- Salah E Shebl
- Urology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
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