Long-term results of tension-free vaginal tape for female urinary incontinence: follow up over 6 years

Long-term Safety of Synthetic Midurethral Sling Implantation for the Treatment of Stress Urinary Incontinence in Adult Women: A Systematic Review

Context

Midurethral slings (MUSs) are the most used therapy for the treatment of stress urinary incontinence (SUI). While warning signals about potential complications have been raised worldwide, there is a lack of safety data especially in the long term.

Objective

Our objective was to evaluate synthetic MUS safety outcomes at long term in adult women.

Evidence acquisition

We included all studies evaluating MUSs in adult women with SUI. All synthetic MUSs have been considered: tension-free vaginal tape (TVT), transobturator tape (TOT), and mini-slings. The primary outcome was the reoperation rate at 5 yr.

Evidence synthesis

Of 5586 references screened after duplicate removal, 44 studies (8218 patients) were included. Among these, nine were randomized controlled trials and 35 were cohort studies. The overall reoperation rates at 5 yr varied between 0% and 19% for TOT (11 studies), 0% and 13% for TVT (17 studies), and 0% and 19% for mini-slings (two studies). The overall reoperation rates at 10 yr varied between 5% and 15% for TOT (four studies) and between 2% and 17% for TVT (four studies). There were few safety data beyond 5 yr: 22.7% of the articles reported a follow-up at ≥10 yr and 2.3% at ≥15 yr.

Conclusions

The incidence rates of reoperations and complications are heterogeneous, and data beyond 5 yr are rare.

Patient summary

There is an urgent need to improve safety monitoring of mesh as our review highlights that available safety data are heterogeneous and of insufficient quality to guide the decision.

Contasure-needleless single incision slings versus transobturator slings (TOT/TVT-O) for female patients with stress urinary incontinence: a systematic review and meta-analysis

Background

To assess the current evidence on the effectiveness and safety of Contasure-Needleless (C-NDL) versus transobturator slings (TOT/TVT-O) in the management of female stress urinary incontinence (SUI).

Methods

A comprehensive literature review of articles that investigated the efficacy and safety of C-NDL and TOT/TVT-O was performed based on studies published before June 2019 and retrieved from PubMed, Embase, CNKI and the Cochrane Library. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software.

Results

Seven studies with 1188 SUI female patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence were included. Our meta-analysis showed that the clinical efficacy of C-NDL is statistically non-inferior to that of TOT / TVT-O in terms of subjective cure rate [OR = 0.77, 95% confidence interval (CI) (0.53 to 1.10), p = 0.15] and objective cure rate [OR = 0.78, 95% CI (0.53 to 1.13), p = 0.19]. In addition, operating times were statistically shorter with C-NDL compared to TOT / TVT-O [mean difference (MD) = − 7.38, 95% CI (− 10.73 to − 4.04), p < 0.0001]. In terms of the postoperative visual analogue scale (VAS) and the incidence of postoperative pain, C-NDL has a greater advantage [MD = − 1.71, 95% CI (− 2.91 to − 0.50), p = 0.005]; [OR = 0.21, 95% CI (0.05 to 0.96), p = 0.04]. Complication rates were statistically similar between the groups, except for groin pain which was higher in TOT / TVT-O.

Conclusion

Our data suggest that C-NDL slings have similar short-term efficacy as TOT/TVT-O in curing SUI patients. Compared with TOT/TVT-O, C-NDL is associated with a shorter operative time, and the incidence of postoperative pain is decreased. Nevertheless, these findings should be further confirmed through large-volume, well-designed prospective randomized controlled trials (RCTs) with long-term follow-up.

The retropubic tension-free vaginal tape procedure-Efficacy, risk factors for recurrence and long-term safety

INTRODUCTION

The retropubic tension-free vaginal tape has been the preferred method for primary surgical treatment of stress urinary incontinence and stress-dominated mixed urinary incontinence in women for more than 20 years. This study presents long-term safety and efficacy data and assesses risk factors for long-term recurrence.

MATERIAL AND METHODS

In a case-series design we assessed a historical cohort of primary surgeries performed with the tension-free vaginal tape procedure in 596 women from 1998 to 2012 with follow up through 2015. Information from the medical records was transferred to a case report form comprising data on early and late complications and recurrence of urinary incontinence defined as bothersome stress urinary incontinence symptoms. All analyses were performed with SPSS using Pearson chi-square, survival and Cox regression analyses.

RESULTS

After a 10-year follow up, mixed urinary incontinent women (hazard ratio 2.1, 95% confidence interval [CI] 1.4-3.0) had a significantly increased risk of recurrence of stress urinary incontinence symptoms compared with women with pure stress urinary incontinence as the indication for surgery. Overall cumulative cure rates after 1, 5 and 10 years were 92% (95% CI; 90%-94%), 79% (95% CI; 75%-83%) and 69% (95% CI; 63%-75%), respectively. Recurrent surgery (0.3%) and serious tape complications needing major surgical treatment (0.3%) were rare. Six patients (1.0%) had the tape cut due to urinary retention, and nine patients (1.5%) reported urinary retention more than 3 months after surgery.

CONCLUSIONS

The tension-free vaginal tape procedure has a high long-term durability. Mixed urinary incontinence as an indication for surgery predicted long-term recurrence. Long-term complications were rare.

Bladder dysfunction does not affect long-term success rate of the retropubic suburethral sling procedure in women with stress urinary incontinence

OBJECTIVE

This study investigated the long-term success rate of retropubic suburethral sling in the treatment of women with stress urinary incontinence (SUI) and different bladder function.

METHODS

Surgical outcomes of women with SUI undergoing a retropubic suburethral sling procedure between October 1989 and November 2014 were analyzed retrospectively. Bladder function was evaluated in every patient preoperatively using videourodynamic studies. Patients were classified as having stable bladder, detrusor overactivity (DO), or detrusor underactivity (DU). Baseline urodynamic parameters were analyzed and long-term therapeutic outcomes were compared among these three groups.

RESULTS

In all, 403 patients underwent sling procedure for SUI. Of these, 291 (72.2%) had a stable bladder, 78 (19.4%) had DO, and 34 (8.4%) had DU. Mean (± SD) patient age was 60.2 ± 11.8 years, and the median follow-up was 97 months (interquartile range 24-325 months). Postoperatively, the overall continence rate was 83.4% (336/403). After surgery, 71 patients (17.6%) complained of dysuria, 14 (3.5%) complained of urgency incontinence, 25 (6.2%) had recurrent SUI requiring a secondary sling procedure, and urethrolysis was performed in 13 (3.2%). In the stable bladder, DO, and DU groups, the 5-year continence rates were 88.6%, 84.1%, and 79.4%, respectively (P = 0.59), whereas the 10-year continence rates were 83.8%, 72.9%, and 79.4%, respectively. Kaplan-Meier survival analysis indicated that the long-term success rate was similar among the three groups (P = 0.39).

CONCLUSIONS

The overall continence rate was 83.4% and the 10-year continence rate was satisfactory in all bladder function subgroups. Treatment outcomes were the same for women with SUI but different bladder function.

The Impact of Complications on Patients' Assessment of the Outcome of Tension-Free Vaginal Tape Procedure

Introduction:

Our study aimed to assess the impact of managed complications of tension-free vaginal tape (TVT) on the patients’ assessment of the results as measured by Patient Global Impression of Improvement (PGI-I).

Materials and methods:

This was a retrospective study, supplemented with a telephone interview, comparing patients who had complications of TVT procedures with those where no complications recorded. The primary outcome was the PGI-I score in the 2 groups.

Results:

A total of 118 invitations were sent. In all, 60 patients returned the signed consent and completed the telephone interview with one of the authors (response rate = 50.8%). Complications were recorded in 21 patients (group 1) and no complications in 39 patients (group 2). There was no statistically significant difference between PGI-I in both groups.

Conclusions:

Managed complications of TVT do not seem to affect patients’ assessment of outcome as measured by PGI-I score.

Endopelvic free anchor minisling technique for stress urinary incontinence treatment: 10 years of experience

INTRODUCTION AND HYPOTHESIS

We present our 10-year experience in treating stress urinary incontinence (SUI) using a new minisling technique based on a tension-free vaginal tape band designed by our group. The major advantage of this tape is the use of minibelt polypropylene inserted through a single retropubic incision without the use of needles-the Endopelvic Free Anchor (EFA)-based on its location at the midurethra with a U shape. For insertion, each branch is placed using a simple Pean clamp from the vagina with perforation of the endopelvic fascia to achieve a retropubic insertion.

METHODS

From May 2001 to May 2011, we surgically treated 166 women with primary first- or second-degree SUI due to urethral hypermobility without genital prolapse. All were evaluated according to our study protocol, which included clinical and urodynamic evaluation before and 12 months after surgery.

RESULTS

With a median follow-up of 5 (1-11) years, 152 patients (91.6 %) were fully cured both from urodynamic and subjective points of view. Six patients (3.6 %) had significant improvement, and eight (4.8 %) were identified as technique failure. Complications included one bladder perforation (0.6 %), two cases of postoperative urinary retention (1.24 %), two of retropubic hematoma (1.24 %), and one of de novo urgency (0.6 %). No reinterventions were necessary, and there were no major bleeding complications, no chronic pain or de novo dyspareunia, and no voiding difficulty.

CONCLUSIONS

EFA is a viable, safe, and effective technique for treating UI due to urethral hypermobility.

Mixed urinary incontinence: international urogynecological association research and development committee opinion

BACKGROUND AND AIM

The definition as well as the treatment of women with mixed urinary incontinence (MUI) is controversial. Since women with MUI are a heterogeneous group, the treatment of MUI requires an individual assessment of the symptom components: stress urinary incontinence, urinary urgency, urgency urinary incontinence, urinary frequency, and nocturia. The purpose of this paper is to summarize the current literature and give an evidence-based review of the assessment and treatment of MUI.

METHODS

A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the diagnosis and management of MUI was drafted based on a literature review. After evaluation by the entire IUGA R&D Committee, revisions were made, and the final document represents the IUGA R&D Committee Opinion on MUI.

RESULTS

This R&D Committee Opinion reviews the literature on MUI and summarizes the assessment and treatment with evidence-based recommendations.

CONCLUSIONS

The diagnosis of MUI encompasses a very heterogeneous group of women. The evaluation and treatment requires an individualized approach. The use of validated questionnaires is recommended to assess urinary incontinence symptoms and effect on quality of life. Conservative therapy is suggested as a first-line approach; if surgery is contemplated, urodynamic investigation is recommended. Women undergoing surgical treatment for MUI need to be counselled about the possibility of persistence of urinary urgency, frequency and urge incontinence even if stress urinary incontinence is cured.

Long-term Outcome of the Readjustable Sling Procedure for Female Stress Urinary Incontinence With Intrinsic Sphincter Deficiency or Recurrence

Purpose

We evaluated the long-term outcome of a readjustable midurethral sling system (Remeex) in the treatment of recurrence of stress urinary incontinence (SUI) after surgical treatment or SUI with intrinsic sphincter deficiency (ISD).

Materials and Methods

This study included 19 patients who underwent the Remeex procedure with a mean of 45.6 months of follow-up. The patients had responded to a telephone questionnaire. Thirteen patients had ISD, four patients had SUI recurrence, and two patients had both. The questionnaire included subjective cure and satisfaction surveys and also recommended surgery to some patients.

Results

The mean patient age was 69.1 years (range, 50-85 years), the mean parity was 2.79 times (range, 2-5 times), and the mean follow-up period was 45.6 months (range, 21-72 months). The long-term follow-up cure rate was 79%, the improvement rate was 21%, and the fail rate was 0%. The long-term follow-up "very satisfactory" rate was 26.3%, the "satisfactory" rate was 73.7%, and the "usual" and "unsatisfactory" rates were both 0%. In addition to these results, 16 patients (84.2%) would recommend the Remeex procedure to other patients with SUI recurrence or ISD. After the procedure, four patients had urinary retention, three patients had difficulty emptying, and one patient had SUI recurrence. Furthermore, all of the patients subsequently endured sling readjustments.

Conclusions

After long-term follow-up, the Remeex system showed good cure rates and subjective satisfaction rates that were similar to the results found at the 1-year follow-up, and minimal complications were reported. Therefore, the Remeex system is effective in treating patients with SUI recurrence or ISD.

[Tethered tape or the fourth factor. A new cause of recurrent stress incontinence after midurethral tape procedures vaginal tape insertion]

BACKGROUND

This is the first report of a newly identified cause of recurrent stress urinary incontinence (SUI) after midurethral tape insertion.

PATIENTS AND METHODS

This article reports a series of cases with primary or secondary tape failure including clinical presentation and findings, the results of pelvic floor (PF) ultrasound, and the (surgical) correction of malpositioned vaginal tapes.

RESULTS

A vaginal tape for treating SUI must be accurately placed under the mid-third of the urethra and at a distance of 3-5 mm from the urethra. Alignment parallel to the urethra in the urethrovaginal septum is also essential for adequate function. A tethered tape refers to the adhesion of a tape edge to the anterior vaginal wall either during primary wound closure or due to secondary ingrowths and is typically associated with recurrent SUI during activities or changes in posture. Less common is SUI through an increase in pressure from cranially, which occurs when coughing or laughing. "Vaginal polyps" may point to imminent vaginal erosion of the tape. In the sagittal plane, the PF examination will identify an oblique orientation of the tape at rest, an abnormal closeness of the tape to the transducer, and changes in tape shape upon manipulation of the vaginal probe. Once the diagnosis has been established, a tethered tape is easy to correct by realignment or tightening to accomplish correct positioning parallel to the urethra. This measure restores tape function and continence.

CONCLUSION

Primary or secondary failure of a tension-free vaginal tape may be caused by a tethered tape. This complication can be diagnosed on the basis of characteristic findings at PF ultrasound. In most women, the tape position can be corrected and there is no need for tape removal.

Mixed Incontinence: How Best to Manage It?

Although common in women, mixed urinary incontinence (MUI) is under-reported and under-treated. It is linked to concomitant disturbances, which may be due to childbirth, ageing, or other medical conditions, in the complex bladder-urethra coordinated system of urine storage and emptying. Primary care physicians can evaluate MUI through history and simple clinical assessment or they can avail of more complex device and tools, such as urodynamic assessment. There is a wide range of therapeutic options. The recent proliferation of new drug treatments and surgical devices for urinary incontinence offers innovative strategies for therapy but products risk being introduced without long-term safety and efficacy assessment. Direct-to-consumer advertising has increased public awareness of MUI.

Persistent and recurrent stress urinary incontinence following mid-urethral tape surgery in women: a UK perspective

Stress urinary incontinence is a common health problem that affects a large proportion of women in Britain. It poses physical and psychological implications for the affected women and is a frequent indication for referral to tertiary urology centres. Midurethral tape surgery (MUTS) has established itself as the standard first-line surgical treatment as a result of its low morbidity, short hospital stay and high long-term success. Failure of the initial surgery can present as persistent or recurrent symptoms. This is a major challenge to the treating urologists as a result of the complicated nature of the condition and the lack of strong evidence supporting individual treatment modalities. In this article we discuss the factors associated with MUTS failure and the surgical options for its treatment.

The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up

Introduction and hypothesis

The objective of this study was the assessment of the efficiency of the MiniArc for curing stress urinary incontinence.

Methods

Seventy-seven patients, operated on from March 2008 to November 2009, were evaluated in this study. One-year post-operative data are presented. All patients suffered from predominant stress urinary incontinence. After 1 year, response was 74%. Evaluation was performed using a questionnaire consisting of the EuroQol-5 Dimensions, the Patient Global Impression of Improvement, the Incontinence Impact Questionnaire, the Urinary Distress Inventory, the Prolapse/Urinary Incontinence Sexual Questionnaire, short form, and the Defecation Distress Inventory.

Results

One year after surgery, 68% of the patients stated an improvement in their incontinence status, while only 44% stated to be completely dry.

Conclusion

The 1-year follow-up suggests that the MiniArc is less effective in the treatment of stress urinary incontinence than the TVT.

Treatment of mixed urinary incontinence

INTRODUCTION

Mixed urinary incontinence (MUI) is a prevalent condition and imposes a significant impact on a woman's quality of life. Treatment is often challenging, as a single modality may be inadequate for alleviating both the urge and stress component.

MATERIALS AND METHODS

A MEDLINE search was conducted regarding English-language literature pertaining to the pathophysiology, diagnosis of, and treatment for MUI. Non-English language articles were considered if they could be translated into English using GOOGLE translator.

RESULTS

The identification of an ideal single treatment has also been made more challenging by the poor characterization of the pathophysiology of MUI. Behavioral and lifestyle modification, as well as pelvic floor muscle therapy, should be considered first-line options for all women with MUI. Treatment of the urge component with anti-muscarinics is effective; however the stress component is likely to persist after therapy. Anti-incontinence surgery may have a positive impact on both the stress and urge components of MUI, with emerging evidence suggesting that transobturator MUS may be associated with lower rates of de novo and persistent urge component compared to other procedures. The presence of concomitant, preoperative detrusor overactivity has not been consistently associated with postoperative outcomes.

CONCLUSIONS

The optimum treatment of MUI may often require multiple treatment modalities. While surgery may have a positive impact on both the urge and stress component, its implementation should be approached with caution and patients should be carefully selected. Detailed informed consent in women with MUI cannot be overstated.

[Functional results following transobturator and retropubic mid-urethral sling]

OBJECTIVE

To compare functional results following retropubic and transobturator mid-urethral sling procedures.

METHODS

Multicenter randomized controlled trial. Power calculation was based on the rate of bladder injury. The current study concerns an analysis of secondary judgment criteria.

RESULTS

One hundred and forty-nine patients were randomly allocated to either TVT (n=75) or TVT-O (n=74). Among them, 132 women completed a 24-month follow-up. There was no significant difference between the two groups, concerning urodynamics data (excluding uroflowmetry) at 12 months follow-up, functional and sexual results at 6, 12 and 24 months follow-up. Concerning sexual results, an improvement in visual analogue scale scores was observed in both groups at 24 months follow-up with no difference between the two groups: median score increased from 70 (IQR: 50-80) pre-operatively to 90 (IQR: 70-100) at 24 months follow-up (P=0,0004) in TVT-O group and from 70 (IQR: 50-80) to 85 (IQR: 70-100) (P=0,0009) in TVT group.

CONCLUSION

TVT and TVT-O procedures are both associated with an increase in quality of life with no significant differences in functional results at 2 years follow-up.

Comparison of the TVT SECUR System "hammock" and "U" tape positions for management of stress urinary incontinence

OBJECTIVE

To assess the efficacy and complications associated with use of the TVT SECUR System device with placement of the tape in either a "hammock" or "U" position for management of stress urinary incontinence (SUI).

METHODS

A prospective study of patients with SUI allocated into one of two groups: "hammock" or "U" tape placement. Preoperative urodynamic results were compared with results at the 6-month and 1-year follow up. Outcome measures were objective cough test assessment and subjective patient responses to a questionnaire at follow up.

RESULTS

Of 82 patients included in the study, 43 comprised the "hammock" group and 39 comprised the "U" group. The objective cure rate at 1-year follow up was 62.8% (n=27) in the "hammock" group and 71.8% (n=28) in the "U" group. At 1-year follow up, the subjective cure, improvement, and failure rates for the "hammock" group were 60.5%, 13.9%, and 25.7% respectively, and 69.2%, 12.8%, and 17.9% respectively, for the "U" group.

CONCLUSION

The efficacy of the TVT SECUR System was lower (<72%) than the cure rates reported for other TVT procedures; further studies are required.

Long-term outcome of the tension-free vaginal tape procedure in female urinary incontinence: a 6-year follow-up

Purpose

We evaluated the long-term outcomes of the tension-free vaginal tape (TVT) procedure for the treatment of female urinary incontinence (UI).

Materials and Methods

We included 141 patients who underwent the TVT procedure for UI and responded to a questionnaire at the 6-year follow-up. The questionnaire included selected questions of the Korean version of the Bristol Female Lower Urinary Tract Symptom (BFLUTS) questionnaire and questions on patients' satisfaction with the procedure. Subjects were characterized as having been cured if they answered 'never' to the questions about any episodes of urine leakage.

Results

The mean follow-up was 85.5 months. The overall long-term cure rate for UI was 83.0% with a satisfaction rate of 80.1%, whereas the 1-year cure rate was 93.4%. The 1-year vs. 6-year cure rates in patients with urodynamic stress UI (SUI group; n=107) and with mixed UI (MUI group; n=34) were 94.1% vs. 84.1% and 89.8% vs. 79.4%, respectively, with no significant difference between the two groups. Also, long-term satisfaction rates in the SUI and MUI groups were 83.2% and 70.6%, without a significant difference between the two. In the MUI group, the 1-year and 6-year cure rates of urgency UI were 81.9% and 58.8%, respectively. There were no serious long-term complications related to the procedure. Most patients (85.9%) would likely recommend the TVT procedure to others.

Conclusions

After 6 years of follow-up, the TVT procedure showed a somewhat decreased cure rate for the treatment of female UI. However, most patients were satisfied with the procedure.

[Our experience with mini tapes (TVT Secur and MiniArc) in the surgery for stress urinary incontinence]

BACKGROUND

The purpose of this publication is to describe the surgical technique, assess complications and short-term results of TVT secur and MiniArc tapes.

MATERIALS AND METHODS

From October 2006 to August 2007 it was carried out the surgical correction with TVT Secur,Women's Health & Urology, Ethicon, Johnson & Johnson, placing the tape as a hammock, to 51 patients, 38 of them with pure stress incontinence and 13 with mixed incontinence and with an average age of 57 years. From September 2007 to February 2008 41 patients, 33 of them with pure stress incontinence and 8 with mixed incontinence, with an average of age of 58 years were operated with AMS Miniarc swing system tape, posted on hammock. All procedures were performed with sedoanalgesia and Ambulatory Surgery regime. Patients were monitored in outpatient visits one month, 3 months and one year after surgical procedure. Medical history and questionnaire and ICIQ-SF, to which we added a question to quantify the degree of satisfaction, as well as physical examination, were done. We compared the results of both technical procedures and statistical survey was conducted by Student test. [Analysis with SPSS software (V14.0)].

RESULTS

The median follow-up in TVT secur group was 328 days (range 163-522 days) and 101 days (range 41-209 days) inthe MiniArc group. We only had one (TVT secur group) surgical complication in all the series (92 patients) being a bladder perforation. Taking into account that we read a negative test effort as an objective cure in the TVT secur group, 80.4% patients are cured and 90.2% inthe MiniArc group without significant difference between both groups (p 0095). To assess the subjective healing we utilized the ICIQ-SF test and the satisfaction extra-question and we noted that there is no significant difference between the first and third month controls. (90% of patients satisfied). 80% of patients were completely satisfied in the first year control that was only performed to TVT secur group.

CONCLUSION

These new tapes show fewer complications that the TVT-O and TOT tapes and allow the possibility of placement with local anesthesia but further studies are needed.

Midurethral minimally invasive sling procedures for stress urinary incontinence

OBJECTIVE

To provide an update on currently used minimally invasive surgical treatments for stress urinary incontinence in women: tension-free vaginal tape (TVT) procedure, transobturator tape (TOT) procedure, and other midurethral sling devices.

OPTIONS

The discussion is limited to minimally invasive surgical management of stress urinary incontinence in women.

EVIDENCE

A search of PubMed and Cochrane library for articles published in English before the end of February 2008 identified the most relevant literature. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.

VALUES

This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada.

BENEFITS, HARMS, AND COSTS

Counselling for the surgical management of urinary incontinence should consider all benefits, harms, and costs of the surgical options.