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A minimally invasive modified technique for female stress urinary incontinence: transobturator tape without paraurethral dissection. Wideochir Inne Tech Maloinwazyjne 2019; 14:278-283. [PMID: 31118995 PMCID: PMC6528136 DOI: 10.5114/wiitm.2018.77715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Mid-urethral slings, including transobturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape-obturator (TVT-O), and a single incision sling, are the most popular procedures for the treatment of stress urinary incontinence (SUI). Although the classical TOT procedure is a minimally invasive technique, we believe that this technique can be further improved. Aim To determine whether there was a difference in success and complication rates between the classical TOT technique and a novel technique called “modified transobturator tape” (mTOT), which avoids periurethral dissection. Material and methods In total, 98 patients who underwent incontinence surgery between July 2011 and January 2017 were recruited for this prospectively planned study. Of the 98 patients, 47 patients underwent classical TOT, and 51 patients underwent the new mTOT procedure. Incontinence Impact Questionnaire-7 (IIQ-7) and visual analogue scale (VAS) scores were obtained preoperatively and postoperatively. Average or serious symptomatic scores in IIQ-7 were considered as subjective failure. Results Nerve damage, vascular damage, retropubic hematomas, and bladder-urethra erosion were not observed in either group. There were no significant between-group differences in IIQ-7 scores. There were also no between-group differences in postoperative 1-month, 6-month, and 1-year VAS scores, but postoperative first day scores of the mTOT group were significantly lower than those of the classical TOT group (p < 0.05). Conclusions The proposed modified technique provides the same efficiency and reliability as the classic technique but is more advantageous in terms of reduced pain and resumption of earlier sexual activity.
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Intraoperative Vaginal Perforation During Various Mid-Urethral Sling Procedures Treating Female Stress Urinary Incontinence. J INVEST SURG 2018; 33:203-210. [PMID: 30461324 DOI: 10.1080/08941939.2018.1492649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Incidence of intraoperative vaginal perforation is generally considered to be low but varies among different procedures. Vaginal perforation could not only prolong the surgeries and aggravate surgical trauma but also result in postoperative discomfort or even a second surgery. METHOD Vaginal perforation, vaginal epithelial perforation, vaginal wall perforation, vaginal penetration, urinary incontinence were searched in PubMed, Cochrane, Embase database to identify the qualified clinical trial and relevant literature sources were also searched. RESULTS A total of 9223 cases of from 33 trials from literatures and 387 cases from our own trail were analyzed, which provided detailed data on intraoperative vaginal perforation. Incidence of intraoperative vaginal perforation during mid-urethral sling surgery treating stress urinary incontinence was generally low, which was 1.56%. Incidence of intraoperative vaginal perforation during transobturator (TOR) procedure was higher than that during retropubic (RPR) procedure, which were 2.11% and 0.89% respectively. Incidence of intraoperative vaginal perforation during outside-to-inside TOR procedure like TOT and MONARC was higher than that during inside-to-outside TOR procedure like TVT-O, which were 2.74% and 1.52%, respectively. Incidence of intraoperative vaginal perforation during single-incision surgery like H-type TVT-SECUR reached 1.97%, while no report on U-type TVT-SECUR surgeries. CONCLUSION The incidence of intraoperative vaginal during mid-urethral sling procedures for female stress urinary incontinence is fairly high. Vaginal perforation was more common in trans-obturator route (TOR) than retropubic route (RPR). In TOR route, it was less frequent in inside-to-outside procedure than outside-to-inside procedure. Surgery proficiency could also have an impact on this complication.
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Two-Year Follow-Up Results of Transobturator Tape Procedure with and without Concomitant Vaginal Surgery. Urol Int 2018; 100:402-408. [PMID: 29627828 DOI: 10.1159/000488465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims to evaluate the subjective and objective outcomes of the transobturator tape (TOT) procedure performed to treat stress urinary incontinence and to determine the efficacy and safety of the TOT procedure when used along with vaginal surgery. METHODS This is a prospective review of 24 women who had the TOT procedure done only due to stress incontinence; 22 women who underwent concomitant TOT and pelvic floor repair; and 20 women who received concurrent TOT, transvaginal hysterectomy, and sacrospinous ligament fixation. RESULTS When compared to the patients who had TOT with pelvic floor repair, the patients who underwent TOT with hysterectomy declared to have more dyspareunia (p = 0.008) and they were found to have significantly higher post-void residual volume (p = 0.014). When compared to the patients who had only TOT, the patients who underwent TOT with hysterectomy claimed to have more pelvic pain (p = 0.012) and significantly higher post-void residual volume (p = 0.020). CONCLUSION The TOT procedure results in moderately high objective cure rates, and concurrent application of pelvic floor repair or transvaginal hysterectomy does not affect these rates. The relatively higher incidences for voiding problems and pelvic pain in women who underwent TOT, hysterectomy, and sacropinous fixation simultaneously suggest that the extent of surgery directly correlates with the severity of postoperative complications.
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The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta-analysis. Neurourol Urodyn 2018; 37:1199-1211. [PMID: 29331033 DOI: 10.1002/nau.23468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/14/2017] [Indexed: 02/05/2023]
Abstract
AIMS Stress urinary incontinence (SUI) is a common problem worldwide. Mainstream surgical procedures include tension-free vaginal tape (TVT), transobturator tape (TOT), tension-free vaginal tape-obturator (TVT-O), tension-free vaginal tape SECUR (TVT-S), and adjustable single-incision sling (Ajust). The aim of this study was to compare the efficacy and safety of these surgical procedures and assess which surgery is most optimal for SUI by adopting a network meta-analysis (NMA). METHODS Electronic databases including PubMed, Cochrance Library, and Embase database were researched systematically, until March 21, 2017. The randomized controlled trials (RCTs) that compared the efficacy and safety of TVT, TOT, TVT-O, TVT-S, and Ajust were identified. The studies were included in the analysis when met the predefined inclusion criteria. After demographic and outcome data extraction, a network meta-analysis was conducted with software R 3.3.2 and STATA 14.0. Objective cure rate, subjective cure rate, postoperative complication rate, bladder perforation, tape erosion, urinary retention, and postoperative pain were considered as outcomes, and the outcomes were displayed as odds ratios (ORs) and 95% credible intervals (CrI). The consistency of direct and indirect evidence was assessed by node splitting. The ranks based on probabilities of intervention for the different endpoints were performed. RESULTS Fourty-five RCTs with 7295 participants were analyzed. The NMA results revealed that, TVT, TOT, and Ajust had a higher objective cure rate than TVT-O and TVT-S (TVT-O: OR = 0.76, 95%CI [0.61, 0.94]; TVT-S: OR = 0.41, 95%CI [0.28, 0.60]). TVT, TOT, and TVT-O had a superior subjective cure rate than TVT-S and Ajust (Ajust: OR = 0.45, 95%CI [0.20, 0.91]; TVT-S: OR = 0.29, 95%CI [0.15, 0.56]). With TVT as the reference, TVT-S had a statistically lower postoperative complication rate (TVT-S: OR = 0.39, 95%CI [0.16, 0.89]). TVT-O, TVT-S, and TOT had a significantly lower bladder perforation rate (TOT: OR = 0.076, 95%CI [0.0060, 0.37]; TVT-O: OR = 4.1e-17, 95%CI [6.1e-48, 0.0032]; TVT-S: OR = 3.8e-17, 95%CI [1.8e-48, 0.0052]). There were no obvious differences between the five treatments for tape erosion. TVT-O exhibited a less postoperative retention (TVT-O: OR = 0.35, 95%CI [0.16, 0.74]). Probabilities of ranking results indicated that TOT was the treatment with best ranking in efficacy and a relatively high safety. CONCLUSIONS Our study recommend TOT as the optimal regimen for SUI with high efficacy and moderate safety when compared with TVT, TVT-O, TVT-S, and Ajust interventions. However, with the limitation of our study, additional high-quality studies are needed to further evaluate the outcomes.
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Abstract
Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.
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Abstract
BACKGROUND Urinary incontinence is a very common and debilitating problem affecting about 50% of women at some point in their lives. Stress urinary incontinence (SUI) is a predominant cause in 30% to 80% of these women imposing significant health and economic burden on society and the women affected. Mid-urethral sling (MUS) operations are a recognised minimally invasive surgical treatment for SUI. MUS involves the passage of a small strip of tape through either the retropubic or obturator space, with entry or exit points at the lower abdomen or groin, respectively. This review does not include single-incision slings. OBJECTIVES To assess the clinical effects of mid-urethral sling (MUS) operations for the treatment of SUI, urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. SEARCH METHODS We searched: Cochrane Incontinence Specialised Register (including: CENTRAL, MEDLINE, MEDLINE In-Process, ClinicalTrials.gov) (searched 26 June 2014); Embase Classic (January 1947 to Week 25 2014); WHO ICTRP (searched 30 June 2014); reference lists. SELECTION CRITERIA Randomised or quasi-randomised controlled trials amongst women with SUI, USI or MUI, in which both trial arms involve a MUS operation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the methodological quality of potentially eligible studies and extracted data from included trials. MAIN RESULTS We included 81 trials that evaluated 12,113 women. We assessed the quality of evidence for outcomes using the GRADE assessment tool; the quality of most outcomes was moderate, mainly due to risk of bias or imprecision.Fifty-five trials with data contributed by 8652 women compared the use of the transobturator route (TOR) and retropubic route (RPR). There is moderate quality evidence that in the short term (up to one year) the rate of subjective cure of TOR and RPR are similar (RR 0.98, 95% CI 0.96 to 1.00; 36 trials, 5514 women; moderate quality evidence) ranging from 62% to 98% in the TOR group, and from 71% to 97% in the RPR group. Short-term objective cure was similar in the TOR and RPR groups (RR 0.98, 95% CI 0.96 to 1.00; 40 trials, 6145 women). Fewer trials reported medium-term (one to five years) and longer-term (over five years) data, but subjective cure was similar between the groups (RR 0.97, 95% CI 0.87 to 1.09; 5 trials, 683 women; low quality evidence; and RR 0.95, 95% CI 0.80 to 1.12; 4 trials, 714 women; moderate quality evidence, respectively). In the long term, subjective cure rates ranged from 43% to 92% in the TOR group, and from 51% to 88% in the RPR group.MUS procedures performed using the RPR had higher morbidity when compared to TOR, though the overall rate of adverse events remained low. The rate of bladder perforation was lower after TOR (0.6% versus 4.5%; RR 0.13, 95% CI 0.08 to 0.20; 40 trials, 6372 women; moderate quality evidence). Major vascular/visceral injury, mean operating time, operative blood loss and length of hospital stay were lower with TOR.Postoperative voiding dysfunction was less frequent following TOR (RR 0.53, 95% CI 0.43 to 0.65; 37 trials, 6200 women; moderate quality evidence). Overall rates of groin pain were higher in the TOR group (6.4% versus 1.3%; RR 4.12, 95% CI 2.71 to 6.27; 18 trials, 3221 women; moderate quality evidence) whereas suprapubic pain was lower in the TOR group (0.8% versus 2.9%; RR 0.29, 95% CI 0.11 to 0.78); both being of short duration. The overall rate of vaginal tape erosion/exposure/extrusion was low in both groups: 24/1000 instances with TOR compared with 21/1000 for RPR (RR 1.13, 95% CI 0.78 to 1.65; 31 trials, 4743 women; moderate quality evidence). There were only limited data to inform the need for repeat incontinence surgery in the long term, but it was more likely in the TOR group than in the RPR group (RR 8.79, 95% CI 3.36 to 23.00; 4 trials, 695 women; low quality evidence).A retropubic bottom-to-top route was more effective than top-to-bottom route for subjective cure (RR 1.10, 95% CI 1.01 to 1.19; 3 trials, 477 women; moderate quality evidence). It incurred significantly less voiding dysfunction, and led to fewer bladder perforations and vaginal tape erosions.Short-and medium-term subjective cure rates between transobturator tapes passed using a medial-to-lateral as opposed to a lateral-to-medial approach were similar (RR 1.00, 95% CI 0.96 to 1.06; 6 trials, 759 women; moderate quality evidence, and RR 1.06, 95% CI 0.91 to 1.23; 2 trials, 235 women; moderate quality evidence). There was moderate quality evidence that voiding dysfunction was more frequent in the medial-to-lateral group (RR 1.74, 95% CI 1.06 to 2.88; 8 trials, 1121 women; moderate quality evidence), but vaginal perforation was less frequent in the medial-to-lateral route (RR 0.25, 95% CI 0.12 to 0.53; 3 trials, 541 women). Due to the very low quality of the evidence, it is unclear whether the lower rates of vaginal epithelial perforation affected vaginal tape erosion (RR 0.42, 95% CI 0.16 to 1.09; 7 trials, 1087 women; very low quality evidence). AUTHORS' CONCLUSIONS Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have a good safety profile. Irrespective of the routes traversed, they are highly effective in the short and medium term, and accruing evidence demonstrates their effectiveness in the long term. This review illustrates their positive impact on improving the quality of life of women with SUI. However, a brief economic commentary (BEC) identified three studies suggesting that transobturator may be more cost-effective compared with retropubic. Fewer adverse events occur with employment of a transobturator approach with the exception of groin pain. When comparing transobturator techniques of a medial-to-lateral versus a lateral-to-medial insertion, there is no evidence to support the use of one approach over the other. However, a bottom-to-top route was more effective than top-to-bottom route for retropubic tapes.A salient point illustrated throughout this review is the need for reporting of longer-term outcome data from the numerous existing trials. This would substantially increase the evidence base and provide clarification regarding uncertainties about long-term effectiveness and adverse event profile.
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Abstract
BACKGROUND Urinary incontinence is a very common and debilitating problem affecting about 50% of women at some point in their lives. Stress urinary incontinence (SUI) is a contributory or predominant cause in 30% to 80% of these women. Mid-urethral sling (MUS) operations are a recognised minimally invasive surgical treatment for SUI. MUS involves the passage of a small strip of tape through either the retropubic or obturator space, with entry or exit points at the lower abdomen or groin, respectively. This review does not include single incision slings. OBJECTIVES To assess the clinical effects of mid-urethral sling (MUS) operations for the treatment of stress urinary incontinence (SUI), urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE in process, ClinicalTrials.gov and handsearching of journals and conference proceedings (searched 26 June 2014), Embase and Embase Classic (January 1947 to Week 25 2014), WHO ICTRP (searched on 30 June 2014) and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials amongst women with SUI, USI or MUI, in which both trial arms involve a MUS operation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the methodological quality of potentially eligible studies and extracted data from the included trials. MAIN RESULTS We included 81 trials that evaluated 12,113 women. We assessed the quality of evidence for outcomes using the GRADE assessment tool; the quality of most outcomes was moderate, mainly due to risk of bias or imprecision.Fifty-five trials with data contributed by 8652 women compared the use of the transobturator route (TOR) and retropubic route (RPR). There is moderate quality evidence that in the short term (up to one year) the rate of subjective cure of TOR and RPR are similar (RR 0.98, 95% CI 0.96 to 1.00; 36 trials, 5514 women; moderate quality evidence) ranging from 62% to 98% in the TOR group, and from 71% to 97% in the RPR group. Short-term objective cure was similar in the TOR and RPR groups (RR 0.98, 95% CI 0.96 to 1.00; 40 trials, 6145 women). Fewer trials reported medium-term (one to five years) and longer-term (over five years) data, but subjective cure was similar between the groups (RR 0.97, 95% CI 0.87 to 1.09; 5 trials, 683 women; low quality evidence; and RR 0.95, 95% CI 0.80 to 1.12; 4 trials, 714 women; moderate quality evidence, respectively). In the long term, subjective cure rates ranged from 43% to 92% in the TOR group, and from 51% to 88% in the RPR group.MUS procedures performed using the RPR had higher morbidity when compared to TOR, though the overall rate of adverse events remained low. The rate of bladder perforation was lower after TOR (0.6% versus 4.5%; RR 0.13, 95% CI 0.08 to 0.20; 40 trials, 6372 women; moderate quality evidence). Major vascular/visceral injury, mean operating time, operative blood loss and length of hospital stay were lower with TOR.Postoperative voiding dysfunction was less frequent following TOR (RR 0.53, 95% CI 0.43 to 0.65; 37 trials, 6200 women; moderate quality evidence). Overall rates of groin pain were higher in the TOR group (6.4% versus 1.3%; RR 4.12, 95% CI 2.71 to 6.27; 18 trials, 3221 women; moderate quality evidence) whereas suprapubic pain was lower in the TOR group (0.8% versus 2.9%; RR 0.29, 95% CI 0.11 to 0.78); both being of short duration. The overall rate of vaginal tape erosion/exposure/extrusion was low in both groups: 24/1000 instances with TOR compared with 21/1000 for RPR (RR 1.13, 95% CI 0.78 to 1.65; 31 trials, 4743 women; moderate quality evidence). There were only limited data to inform the need for repeat incontinence surgery in the long term, but it was more likely in the TOR group than in the RPR group (RR 8.79, 95% CI 3.36 to 23.00; 4 trials, 695 women; low quality evidence).A retropubic bottom-to-top route was more effective than top-to-bottom route for subjective cure (RR 1.10, 95% CI 1.01 to 1.19; 3 trials, 477 women; moderate quality evidence). It incurred significantly less voiding dysfunction, and led to fewer bladder perforations and vaginal tape erosions.Short-and medium-term subjective cure rates between transobturator tapes passed using a medial-to-lateral as opposed to a lateral-to-medial approach were similar (RR 1.00, 95% CI 0.96 to 1.06; 6 trials, 759 women; moderate quality evidence, and RR 1.06, 95% CI 0.91 to 1.23; 2 trials, 235 women; moderate quality evidence). There was moderate quality evidence that voiding dysfunction was more frequent in the medial-to-lateral group (RR 1.74, 95% CI 1.06 to 2.88; 8 trials, 1121 women; moderate quality evidence), but vaginal perforation was less frequent in the medial-to-lateral route (RR 0.25, 95% CI 0.12 to 0.53; 3 trials, 541 women). Due to the very low quality of the evidence, it is unclear whether the lower rates of vaginal epithelial perforation affected vaginal tape erosion (RR 0.42, 95% CI 0.16 to 1.09; 7 trials, 1087 women; very low quality evidence). AUTHORS' CONCLUSIONS Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have a good safety profile. Irrespective of the routes traversed, they are highly effective in the short and medium term, and accruing evidence demonstrates their effectiveness in the long term. This review illustrates their positive impact on improving the quality of life of women with SUI. With the exception of groin pain, fewer adverse events occur with employment of a transobturator approach. When comparing transobturator techniques of a medial-to-lateral versus a lateral-to-medial insertion, there is no evidence to support the use of one approach over the other. However, a bottom-to-top route was more effective than top-to-bottom route for retropubic tapes.A salient point illustrated throughout this review is the need for reporting of longer-term outcome data from the numerous existing trials. This would substantially increase the evidence base and provide clarification regarding uncertainties about long-term effectiveness and adverse event profile.
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Long Term Follow up of the Solyx Single Incision Sling in the Treatment of Female Stress Urinary Incontinence (SUI). ACTA ACUST UNITED AC 2014. [DOI: 10.4236/oju.2014.42003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Complications from needle placement and exit during a TOT procedure exist and must be considered when placing the needle through the area of the obturator fossa. Background and Objectives: Five cases of pelvic nerve complications after transobturator tape (TOT) inside-out surgical procedures for stress urinary incontinence are presented. Methods: We conducted a chart review of patients with complications referred to our practice. Results: Five patients with nerve complications after TOT inside-out procedures were investigated. Pudendal neuropathy and interstitial cystitis were seen in this series of patients with several patients having myofascial pain in the lower abdominal area. Conclusions: Although not commonly reported, complications from needle placement and from the area of needle exit in a TOT procedure can exist, and the surgeon must be careful when placing the needle through the area of the obturator fossa.
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An anatomic comparison of the original versus a modified inside-out transobturator procedure. Int Urogynecol J 2011; 22:997-1004. [DOI: 10.1007/s00192-011-1415-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 03/13/2011] [Indexed: 11/28/2022]
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Safety and Efficacy of the Solyx Single-Incision Sling for the Treatment of Stress Urinary Incontinence: Preliminary Results. ACTA ACUST UNITED AC 2011. [DOI: 10.3834/uij.1944-5784.2011.02.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Répercussions cliniques et urodynamiques du traitement de l’incontinence urinaire d’effort par bandelettes sous-urétrales transobturatrice. Prog Urol 2010; 20:369-74. [DOI: 10.1016/j.purol.2009.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 09/23/2009] [Accepted: 09/24/2009] [Indexed: 11/18/2022]
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Comparison of retropubic and transobturator tension-free vaginal implants for the treatment of stress urinary incontinence. Int J Gynaecol Obstet 2010; 110:23-6. [DOI: 10.1016/j.ijgo.2010.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 02/11/2010] [Accepted: 03/19/2010] [Indexed: 11/29/2022]
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MiniArc™ : étude prospective et suivi à un an d’une série de 72 patientes. ACTA ACUST UNITED AC 2010; 39:25-9. [DOI: 10.1016/j.jgyn.2009.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 10/20/2009] [Accepted: 10/26/2009] [Indexed: 11/20/2022]
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Preliminary findings with the Solyx™ single-incision sling system in female stress urinary incontinence. Int Urogynecol J 2009; 21:557-61. [DOI: 10.1007/s00192-009-1065-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 11/25/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common condition affecting up to 30% of women. Minimally invasive synthetic suburethral sling operations are among the latest forms of procedures introduced to treat SUI. OBJECTIVES To assess the effects of minimally invasive synthetic suburethral sling operations for treatment of SUI, urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. SEARCH STRATEGY We searched the Cochrane Incontinence Group Specialised Register (searched 20 March 2008), MEDLINE (January 1950 to April 2008), EMBASE (January 1988 to April 2008), CINAHL (January 1982 to April 2008), AMED (January 1985 to April 2008), the UK National Research Register, ClinicalTrials.gov, and reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials amongst women with SUI, USI or symptoms of stress or mixed urinary incontinence, in which at least one trial arm involved a minimally invasive synthetic suburethral sling operations. DATA COLLECTION AND ANALYSIS Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trials. MAIN RESULTS Sixty two trials involving 7101 women were included. The quality of evidence was moderate for most trials. Minimally invasive synthetic suburethral sling operations appeared to be as effective as traditional suburethral slings ( trials, n = 599, Risk Ratio (RR) 1.03, 95% Confidence Interval (CI) 0.94 to 1.13) but with shorter operating time and less post-operative voiding dysfunction and de novo urgency symptoms.Minimally invasive synthetic suburethral sling operations appeared to be as effective as open retropubic colposuspension (subjective cure rate at 12 months RR 0.96, 95% CI 0.90 to 1.03; at 5 years RR 0.91, 95% CI 0.74 to 1.12) with fewer perioperative complications, less postoperative voiding dysfunction, shorter operative time and hospital stay but significantly more bladder perforations (6% versus 1%, RR 4.24, 95% CI 1.71 to 10.52).There was conflicting evidence about the effectiveness of minimally invasive synthetic suburethral sling operations compared to laparoscopic colposuspension in the short term (objective cure, RR 1.15, 95% CI 1.06 to 1.24; subjective cure RR 1.11, 95% CI 0.99 to 1.24). Minimally invasive synthetic suburethral sling operations had significantly less de novo urgency and urgency incontinence, shorter operating time, hospital stay and time to return to daily activities.A retropubic bottom-to-top route was more effective than top-to-bottom route (RR 1.10, 95% CI 1.01 to 1.20; RR 1.06, 95% CI 1.01 to 1.11) and incurred significantly less voiding dysfunction, bladder perforations and tape erosions.Monofilament tapes had significantly higher objective cure rates (RR 1.15, 95% CI 1.02 to 1.30) compared to multifilament tapes and fewer tape erosions (1.3% versus 6% RR 0.25, 95% CI 0.06 to 1.00).The obturator route was less favourable than the retropubic route in objective cure (84% versus 88%; RR 0.96, 95% CI 0.93 to 0.99; 17 trials, n = 2434), although there was no difference in subjective cure rates. However, there was less voiding dysfunction, blood loss, bladder perforation (0.3% versus 5.5%, RR 0.14, 95% CI 0.07 to 0.26) and shorter operating time with the obturator route. AUTHORS' CONCLUSIONS The current evidence base suggests that minimally invasive synthetic suburethral sling operations are as effective as traditional suburethral slings, open retropubic colposuspension and laparoscopic colposuspension in the short term but with less postoperative complications. Women were less likely to be continent after operations performed via the obturator (rather than retropubic) route, but they had fewer complications. Most of the trials had short term follow up and the quality of the evidence was variable.
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TVT Secur™ : étude prospective et suivi à un an de 154 patientes. ACTA ACUST UNITED AC 2009; 38:299-303. [PMID: 19403242 DOI: 10.1016/j.jgyn.2009.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/14/2009] [Accepted: 03/02/2009] [Indexed: 11/24/2022]
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Irritative symptoms are the main predictor of satisfaction rate in women after transobturator tape procedures. Int Urogynecol J 2009; 20:791-6. [DOI: 10.1007/s00192-009-0868-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update. Int Urogynecol J 2008; 20:337-48. [DOI: 10.1007/s00192-008-0753-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
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Closing the chapter on obtape: a case report of delayed thigh abscess and a literature review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:143-147. [PMID: 18254996 DOI: 10.1016/s1701-2163(16)32738-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a case of delayed abscess formation 33 months after Obtape transobturator tape insertion, and we review the relevant literature. CASE A 73-year-old woman presented with groin pain, swelling, and purulent discharge 33 months after Obtape insertion. Examination showed a vaginal erosion and right groin abscess. Oral antibiotics resulted in significant symptomatic improvement. The patient underwent complete tape removal and drainage of infection. She continues to suffer from urinary incontinence. CONCLUSION Abscess formation and undiagnosed mesh erosion can occur up to 33 months after Obtape insertion, longer than previous reports have described. This highlights the need for continued vigilance in patients who have undergone Obtape insertion. Vaginal mesh erosions warrant careful repair in order to avoid delayed infectious complications.
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TVT-O for the Treatment of Female Stress Urinary Incontinence: Results of a Prospective Study after a 3-Year Minimum Follow-Up. Eur Urol 2008; 53:401-8. [PMID: 17728052 DOI: 10.1016/j.eururo.2007.08.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 08/10/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown. We analyzed the 3-yr results of a prospective, observational study designed to evaluate the safety and efficacy of the TVT-O procedure. METHODS Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual (PVR) measurement, and urinary symptoms and quality of life (QoL) questionnaires. Data were compared by means of the Wilcoxon matched pairs test. RESULTS Between March 2003 and December 2003, 102 consecutive patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria underwent the TVT-O procedure; the latter was associated with pelvic organ prolapse treatment in 16 patients (15.7%). Three-year minimum follow-up (median, 40 mo) was available for 91 patients (89.2%). No erosion or persistent pain was noted. Four patients required tape release or section. Disappearance and improvement of SUI were observed in 88.4% and 9.3% of the patients, respectively. These cure rates were similar to those obtained 1 yr after the operation (p=0.55). Frequency and urge symptoms were improved at 3 yr (p<0.005). Whereas maximum flow rates were somewhat decreased (p=0.01), the severity of obstructive symptoms and PVR volumes were not statistically different (p=0.11 and p=0.32, respectively). Incontinence severity and QoL scale scores were largely better than preoperative ones (p<0.001) and did not differ from those reported at 1 yr (p=0.15 and p=0.08, respectively). CONCLUSIONS The TVT-O procedure is a safe and efficient treatment of female SUI, with maintenance of high cure rates after a 3-yr minimum follow-up.
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A comprehensive review of suburethral sling procedure complications. J Minim Invasive Gynecol 2008; 15:132-45. [PMID: 18312981 DOI: 10.1016/j.jmig.2007.11.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Revised: 11/17/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
Abstract
The study objective was to review the existing literature regarding complications of anti-incontinence sling procedures. PubMed listings using keywords related to slings and associated complications with no date or language restrictions through May 2007 and the Manufacturer and User Facility Device Experience Database were searched for specific device- and procedure-related complications. Where no information was available, published abstracts were cited. Published reports of complications for all types of anti-incontinence sling procedures are analyzed and reported. Sling-related complications are multiple but can be summarized from studies on 13737 cumulative patients as involving: voiding dysfunction (8 studies, 881 patients, 16.3% average overall incidence [OI]); detrusor overactivity (20 studies, 1950 patients, 15.4% OI); urinary retention (14 studies, 943 patients, 14.2% OI); erosion/extrusion (19 studies, 2197 patients, 6.03% OI); impact on quality of life-dyspareunia (2 studies, 175 patients, 4.3% OI); infections-most often urinary tract infections but severe infections such as abscess are reported (19 studies, 1487 patients, 5.5% OI); hematoma-most often pelvic or vaginal (4 studies, 3691 patients, 2% OI); pain (6 studies, 597 patients, 7.3% OI); abdominal and pelvic organ injury-bladder, urethra, vagina, and intestines (10 studies, 1816 patients, 3.3% OI); systemic complications-deep vein thrombosis, sepsis (case reports); and death (case reports). Cure rates for all slings are as follows: subjective (16 studies, 1541 patients, 95% OI, range 63%-99%), objective (15 studies, 1203 patients, 82% OI, range 51%-97%), and failure (8 studies, 599 patients, 11.5% OI, range 4%-37%). It is likely that sling-related complications are under-reported in the published medical literature and in the Manufacturer and User Facility Device Experience Database. This review reports on the incidence of known complications for all types of slings. Some complications are common to all sling techniques; however, with development of minimally invasive slings, device-related complications are reported and compared.
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The safety of the inside-out transobturator approach for transvaginal tape (TVT-O) treatment in stress urinary incontinence: French registry data on 984 women. Int Urogynecol J 2008; 19:711-5. [DOI: 10.1007/s00192-007-0514-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 11/10/2007] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Surgical management of female stress incontinence has progressed rapidly over the past decade. The purpose of this review is to provide up-to-date information regarding surgical outcomes of midurethral slings and to discuss management of sling complications. Additionally, the newer commercially available products will be outlined and the data comparing new versus established techniques will be examined. RECENT FINDINGS Long-term data are available for the Tension-free Vaginal Tape procedure which demonstrates durable efficacy. Comparisons between the Tension-free Vaginal Tape and Suprapubic Arch sling procedure demonstrate no significant difference in cure rates or complications. In an effort to avoid the retropubic space, the transobturator slings were developed and short-term data suggest similar efficacy to the transabdominal techniques. The transobturator approach, while limiting abdominal complications, is not without its own complication profile. Increased experience with synthetic mesh in vaginal surgery has allowed for a more systematic approach to managing mesh erosions. SUMMARY The literature indicates that midurethral slings, despite the specific approach, are efficacious and an important therapy in managing stress incontinence. Prospective data will be needed before the surgeon can determine if the new products and techniques are truly an improvement over the existing products or merely a proprietary modification.
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Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol 2007; 52:663-78. [PMID: 17601652 DOI: 10.1016/j.eururo.2007.06.018] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 06/11/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the efficacy of tension-free vaginal tape (TVT) compared with other surgical treatments for stress urinary incontinence (SUI) and with other tension-free midurethral slings. METHODS A systematic review of the literature was performed in January 2007 using MEDLINE, Embase, and Web of Science. The searches used both "MeSH" and "free text" protocols. Meta-analysis was conducted using the Review Manager software 4.2 (Cochrane Collaboration). RESULTS Our search identified 37 randomized controlled trials. According to the Jadad score, the quality of the evaluated studies was limited in most papers. TVT outperformed Burch colposuspension in terms of postoperative continence rates (odds ratio [OR] from 0.38 to 0.59, according to the different end points), whereas success rates were similar after TVT and pubovaginal slings. Comparing TVT to the other retropubic tension-free midurethral vaginal slings, TVT was more efficacious than both intravaginal slingplasty (IVS; OR = 0.47; p = 0.007) and suprapubic arc (SPARC; OR from 0.53 to 0.56 according to the different evaluated end points). Indeed, the available data suggest similar efficacy for retropubic and trans-obturator tapes both in terms of subjective (OR = 0.98; p = 0.92) and objective (OR = 0.81; p = 0.34) cure rates. CONCLUSIONS Our meta-analysis showed that TVT outperformed Burch colposuspension; efficacies of TVT and pubovaginal sling were similar. TVT was more efficacious than IVS and SPARC, whereas retropubic and trans-obturator tapes showed overlapping cure rates. The poor quality of most of the studies, both in terms of methodologic and clinical parameters, limits the strengths of the recommendations derived by the meta-analysis.
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The use of synthetic sub-urethral slings in the treatment of female stress urinary incontinence. Int Urogynecol J 2007; 18:1087-95. [PMID: 17464439 DOI: 10.1007/s00192-007-0347-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
We set out to review the existing literature regarding the use of synthetic suburethral sling products for the treatment of female stress urinary incontinence. Products currently implanted are examined and scrutinized, and evidence regarding their efficacy and complication rates is noted. Additionally, specifics of presently utilized synthetic materials, including construction method and biocompatibility, are explored and directly correlated to currently marketed products. This investigation was undertaken with the use of the Medline database. Studies pertaining to synthetic or surgical mesh, as well as each specific suburethral sling product, are included. Our findings and ultimately our recommendations stem from the preponderance of evidence supporting the continued use of knitted, macroporous polypropelene mesh slings. Several existing marketed products detailed in the study fit this description. Specific reference is made to recent reports of vaginal erosions and deep space infections related to several specific products. A cautionary note is also made regarding the implantation of transobturator sling products currently marketed without the necessary pre-market testing, potentially placing the public at risk. From the currently available literature on biomaterials, it seems clear that knitted macroporous polypropylene is the material of choice for suburethral implantation. With respect to the means and techniques by which these mesh materials are suburethrally implanted, the surgeon's choice often dictates which method is used, but recent experience has demonstrated that the transobturator approach can be equally as effective as the traditional tension-free vaginal tape, with less-associated morbidity. Ongoing randomized controlled trials will further clarify and distinguish between methods.
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Anatomical variability in the trajectory of the inside-out transobturator vaginal tape technique (TVT-O). Int Urogynecol J 2007; 18:1201-6. [PMID: 17384896 DOI: 10.1007/s00192-007-0303-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2006] [Accepted: 01/06/2007] [Indexed: 11/28/2022]
Abstract
An experimental surgical study on human cadavers was undertaken to assess variability in the trajectory followed by the needle during application of the inside-out transobturator tape suspension (TVT-O) technique. The TVT-O surgical procedures were performed on six fresh female cadavers according to the standard recommended operative protocol. Subsequent anatomical dissection revealed that the needle had perforated the obturator membrane at a distance of 0.7 to 2.0 cm from the needle to the obturator canal. It subsequently followed a variable course passing at 0.5 to 2.0 cm from the anterior branch of the obturator nerve and 0.1 to 1.4 cm from the posterior branch. We conclude from this anatomical study that the TVT-O trajectory is subject to wider variability than was originally postulated.
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Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG 2007; 114:522-31. [PMID: 17362484 DOI: 10.1111/j.1471-0528.2007.01268.x] [Citation(s) in RCA: 311] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various types of suburethral tapes inserted via the transobturator route (tension-free vaginal tape obturator route [TVTO] and transobturator tape [TOT]) have been widely adopted for treatment of stress urinary incontinence (SUI) before proper evaluation of their effectiveness and complications. OBJECTIVES To assess the effectiveness and complications of TOTs as treatment of SUI by means of a systematic review. SEARCH STRATEGY MEDLINE, EMBASE, CINAHL, LILIACS (up to September 2006), CENTRAL (The Cochrane Library, Issue 3, 2006), MetaRegister of Controlled Trials, The National Library for Health, the National Research Register and Google Scholar were searched using various relevant search terms. The citation lists of review articles and included trials were searched, and contact with the corresponding author of each included trials was attempted. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared the effectiveness of TVTO or TOT with synthetic tension-free vaginal tape (TVT) by retropubic route (Gynecare; Ethicon Inc., NJ, USA) for the treatment of SUI in all languages were included. DATA COLLECTION AND ANALYSIS Two reviewers extracted data on participants' characteristics, study quality, population, intervention, cure and adverse effects independently. The data were analysed in the Review Manager 4.2.8 software. MAIN RESULTS There were five RCTs that compared TVTO with TVT and six RCTs that compared TOT with TVT. When compared by subjective cure, TVTO and TOT at 2-12 months were no better than TVT (OR 0.85; 95% CI 0.60-1.21). Adverse events such as bladder injuries (OR 0.12; 95% CI 0.05-0.33) and voiding difficulties (OR 0.55; 95% CI 0.31-0.98) were less common, whereas groin/thigh pain (OR 8.28; 95% CI 2.7-25.4), vaginal injuries or erosion of mesh (OR 1.96; 95% CI 0.87-4.39) were more common after tape insertion by the transobturator route. AUTHOR'S CONCLUSIONS The evidence for short-term superiority of effectiveness of TOTs is currently limited. Bladder injuries and voiding difficulties are lower, but the risk of vaginal erosions and groin pain is higher with TVTO/TOT. Methodologically sound and sufficiently powered RCTs with long-term follow up are needed, and the results of continuing trials are awaited.
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TOT en el tratamiento de la incontinencia de esfuerzo: nuestra experiencia, comparándola con la TVT. Actas Urol Esp 2007; 31:1134-40. [DOI: 10.1016/s0210-4806(07)73776-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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