Functional outcomes and quality of life after transobturatory slings: hand - made vs. commercial slings

Abstract

Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings.Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros- pectively collected between 2012 and 2014, and divided in two groups for further compa- rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test.Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de- mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

Incontinence outcomes in women undergoing retropubic mid-urethral sling: a retrospective cohort study comparing Safyre™ and handmade sling

“…Loss of follow-up in the study (37%) may have been seen as an inherent limitation, but similar rates have been previously reported by Kuprasertkul and Zimmern, who demonstrated rates of loss ranging from 10 to 49% over 10 years follow-up (19). A limited number of publications have studied Safyre™ and all of them used a transobturator approach, with bladder perforation rates varying between 0 -4.2% (1,9,10). Risk factors for bladder injury in this context may include previous pelvic surgeries (cesarean section, colposuspension, rectocele), inexperienced surgeons, local anesthesia, younger patient age and lower body mass index (BMI) (4,20).…”

“…In a retrospective study comparing transobturator HMS and commercial slings, Ciftci et al reported similar subjective cure rates in both groups after a 12-month follow-up (8) and Lou-renço et al found a comparable rate of subjective cure rates (9). Other authors found subjective cure rates between 59% and 90% (13,15,21).…”

“…The importance of reporting the presence of vaginal extrusions has increased in recent years. Several authors who have published studies with homemade slings do not report local complications with the mesh, prioritizing only the reporting of voiding complications (8)(9)(10)(11)(12). Vaginal extrusion rates showed a higher tendency in the HMS group.…”

“…However, commercial kits can be expensive, especially in developing countries, restricting their access, particularly in the public health system (8)(9)(10)(11)(12). Therefore, low-cost hand-made synthetic slings (HMS) have been proposed as an alternative to expand their access (8)(9)(10)(11)(12).…”

Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review

“…1, 2 UVF has also been reported as a rare complication of antiincontinence sling procedures, including tension-free transvaginal tape (TVT) and transobturator tape placement 3 , likely secondary to tension necrosis of the urethra. [4][5][6] Continuous incontinence associated with UVF may mask associated stress urinary incontinence (SUI). Simultaneous surgical correction of incontinence at the time of UVF repair to avoid a secondary surgical intervention is controversial, 7, 8 however small cohort studies have reported concomitant incontinence procedures with success.…”