A series of Advantage suburethral slings

Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review

Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.

The long term predictive value of preoperative pressure flow studies in the resolution of overactive bladder after insertion of a retropubic midurethral sling

AIMS

To identify if the short term association of pressure flow rates with resolution of overactive bladder (OAB) is maintained in the long term in patients with mixed urodynamic incontinence treated with a retropubic midurethral sling. To assess if other demographic factors are associated with the long term resolution of OAB.

METHODS

This was follow up study of a consecutive case series of 100 patients treated with a MUS at a single center followed up with questionnaires. Preoperative pressure flow studies were compared to the resolution of urgency and urgency incontinence after surgery.

RESULTS

A total of 6.25 years after surgery, resolution of urgency and urgency incontinence was associated with a higher preoperative flow rate (26.7 mL/s vs 19.1 mL/s P = 0.02) and a higher flow rate centile (33.1 vs 14.0 P = 0.01). No other demographic parameters were associated with resolution of OAB.

CONCLUSIONS

The long term outcome and resolution of urgency and urgency incontinence can be predicted by preoperative pressure flow studies over 6 years after surgery.

Transvaginal retropubic sling systems: efficacy and patient acceptability

Stress urinary incontinence is a common, disabling, and costly medical problem that affects approximately 50% of women with urinary incontinence. Suburethral retropubic slings have been developed as a minimally invasive and effective surgical option, and they have been used as a first-line treatment for stress urinary incontinence since 1995. However, complications including vaginal extrusion, erosion, pain, bleeding, infections, lower urinary tract symptoms, urinary retention, and incontinence have been reported with use of the slings. Several companies manufacture sling kits, and the sling kits vary with regard to the composition of the mesh and introducer needle. The aim of this review was to determine which sling kit was most effective for patients, had minimal reported side effects, and was best accepted by patients and surgeons. In a review of the literature, it was found that a total of 38 studies were published between 1995 and 2014 that reported on eight tension-free retropubic sling kits: SPARC, RetroArc, Align, Advantage, Lynx, Desara, Supris, and Gynecare TVT. The Gynecare TVT was the most cited sling kit; the second most cited was the SPARC. This review provides a summary of the studies that have examined positive and negative outcomes of the retropubic tension-free suburethral sling procedure using various sling kits. Overall, the results of the literature review indicated that data from comparisons of the available sling kits are insufficient to make an evidenced-based recommendation. Therefore, the decision regarding which sling kit is appropriate to use in surgery is determined by the medical provider’s preference, training, and past experience, and not by the patient.