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Khafagy W, ElBassioune W, Rady M, Farouk E, Elhelw E, Saeed A, Mahmoud A, Abuelmatti H, Elsheikh A, Mahmoud M, Hussein M, Zaky A, Abdeltawab A, Ali S, Altoraky M, Hegazy M, Almorsy A, Alghazaly M, Rehan M, Elnady E, Khater S, Mahmoud A, Elsayed A, Deif H. A new promising approach to urodynamic stress urinary incontinence care can help menopausal women. Prz Menopauzalny 2023; 22:121-125. [PMID: 37829269 PMCID: PMC10566331 DOI: 10.5114/pm.2023.131058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/15/2022] [Indexed: 10/14/2023]
Abstract
Introduction The goal of this study is to evaluate the effectiveness of single-incision mini-sling in the surgical treatment of postmenopausal urodynamic stress urinary incontinence (SUI) compared to the standard trans-obturator mid-urethral sling. Material and methods This prospective study was carried out in two tertiary centres; Al-Azhar University Maternity & Urology Hospitals. A total of 120 postmenopausal women with urodynamic SUI were randomized to undergo either single-incision mini-sling (n = 60) or standard trans-obturator mid-urethral sling procedure (n = 60) from May 2019 until Oct 2021. Main outcome measures: efficacy was evaluated utilizing objective cure rate (cough stress test) and subjective cure rate (Sandvik incontinence severity index and International Consultations on Incontinence Questionnaire - Short Form), intraoperative and postoperative complications, and postoperative pain (using a visual analogue scale). Results The single-incision mini-sling (SIMS) and transobturator tape (TOT) groups had no statistically significant difference in subjective and objective cure rates (p > 0.05). Compared with the transvaginal tape O group, patients in the SIMS group had significantly less postoperative pain, shorter operative duration, and less intraoperative blood loss (all p-values < 0.05). No significant difference in perioperative complications was observed between both groups. Conclusions Single-incision mini-sling was superior to TOT in postmenopausal as SIMS is of similar effectiveness, more safe and minimally invasive with earlier ambulance.
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Affiliation(s)
- Wael Khafagy
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Walaa ElBassioune
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Mahmoud Rady
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Elmetwally Farouk
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Ehab Elhelw
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Ahmed Saeed
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Ahmed Mahmoud
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Hamada Abuelmatti
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Ahmed Elsheikh
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Mohamed Mahmoud
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Mohammed Hussein
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Ahmed Zaky
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Ahmed Abdeltawab
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Soliman Ali
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Muhammad Altoraky
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Mahmoud Hegazy
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Ahmed Almorsy
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Moatazza Alghazaly
- Department of Obstetrics and Gynaecology, Al-Azhar University, Al-Azhar, Egypt
| | - Mohamed Rehan
- Department of Urology, Al-Azhar University, Al-Azhar, Egypt
| | - Esam Elnady
- Department of Urology, Al-Azhar University, Al-Azhar, Egypt
| | - Saed Khater
- Department of Urology, Al-Azhar University, Al-Azhar, Egypt
| | - Alaa Mahmoud
- Department of Urology, Al-Azhar University, Al-Azhar, Egypt
| | - Ahmed Elsayed
- Department of Urology, Al-Azhar University, Al-Azhar, Egypt
| | - Hazem Deif
- Department of Urology, Al-Azhar University, Al-Azhar, Egypt
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Jiao B, Lai S, Xu X, Zhang M, Diao T, Zhang G. A systematic review and meta-analysis of single-incision mini-slings (MiniArc) versus transobturator mid-urethral slings in surgical management of female stress urinary incontinence. Medicine (Baltimore) 2018; 97:e0283. [PMID: 29620645 PMCID: PMC5902257 DOI: 10.1097/md.0000000000010283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To assess the current evidence of effectiveness and safety of single-incision mini-slings (MiniArc) versus transobturator midurethral slings in the management of female stress urinary incontinence (SUI). METHODS A systematic search was performed from the electronic databases including PubMed, EMBASE, and Cochrane Library by November 2017. Using RevMan5.3 statistical software, the primary outcomes including subject and objective cure rates at 6 to 24 months follow-up were evaluated. Meanwhile, analysis was also performed for comparing the secondary outcomes such as peri- and postoperative complications, operative data, and quality of life. RESULTS Six randomized controlled trials (RCTs) and 6 retrospective cohort studies involving 1794 patients with SUI were analyzed based on the inclusion criteria. On the basis of our analysis, MiniArc was proven to have a noninferior clinical efficacy compared with transobturator midurethral slings with respect to the objective cure rate (risk ratio [RR] = 0.98, 95% confidence interval [CI] 0.94-1.03, P = .43) and subjective cure rate (RR = 0.97, 95% CI 0.91-1. 04, P = .38). In addition, pooled analysis showed that MiniArc had significantly lower postoperative pain scores (mean difference [MD] = -1.70, 95% CI -3.17 to -0.23, P = .02) and less postoperative groin pain (RR = 0.42, 95% CI 0.18-0.98, P = .04). Moreover, the MiniArc group also had a significantly shorter operation time (MD = -6.12, 95% CI -8.61 to -3.64, P < .001), less blood loss (MD = -16.67, 95% CI -26.29 to -7.05, P < .001), shorter in-patient stay (MD = 1.30, 95% CI -1.74 to -0.86, P < .001), and less urinary retention risk (RR = 1.15, 95% CI 0.46-2.87, P = .77). However, overall evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MiniArc compared with transobturator slings. CONCLUSIONS This meta-analysis indicates that MiniArc is an effective method treating SUI. When compared with transobturator slings, it not only has a similar high cure rates, but also is associated with shorter operation time, less blood loss, more favorable recovery time, lower postoperative pain scores, less postoperative groin pain, less urinary retention, and absence of a visible wound. However, the findings of this study should be further confirmed by well-designed prospective RCTs with a larger patient series.
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Affiliation(s)
- Binbin Jiao
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
| | - Shicong Lai
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
| | - Xin Xu
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Meng Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
| | - Tongxiang Diao
- Peking University Fifth School of Clinical Medicine
- Department of Urology, Beijing Hospital, Dongcheng, Beijing, China
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
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LEANZA V, INTAGLIATA E, LEANZA A, FERLA F, LEANZA G, VECCHIO R. Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence. G Chir 2014; 35:80-84. [PMID: 24841685 PMCID: PMC4321593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. STUDY DESIGN A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard midurethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. RESULTS In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. CONCLUSIONS Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques.
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