Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of Sparc and Monarc slings

Abstract

Purpose: The treatment of patients with intrinsic sphincteric deficiency (ISD) remains difficult. It is theorized that differing vectors of support provided by retropubic versus transobturator mid-urethral sling routes may affect outcomes. We sought to compare outcomes of patients undergoing SPARC versus MONARC sling types in patients with Valsalva leak point pressures (VLPPs) below 60 cm H2O. Materials and Methods: A retrospective review of female patients with stress urinary incontinence undergoing SPARC&#8482; (n = 97) or MONARC&#8482; (n = 39) placement following urodynamic diagnosis of ISD was performed, with minimum 12-month follow-up required. Outcomes were assessed using a questionnaire comprising validated incontinence questionnaires (UDI-6, IIQ-7) and additional items addressing satisfaction. Results: Success rates of 76% and 77% were observed in the SPARC (mean follow-up 36 months) and MONARC (mean follow-up 32 months) cohorts, respectively (p > 0.05). Superior UDI scores were demonstrated in the MONARC cohort (3.8 vs. 5.3, p = 0.04)), in contrast to similar IIQ scores across both groups (3.7 vs. 3.1, p > 0.05). A deterioration in success rates was seen in both cohorts with more extended follow-up and with lower VLPPs. However, this finding was limited by low patient numbers in these cohorts. A complication rate of 7% and 3% was noted in SPARC and MONARC cohorts (p > 0.05). Conclusions: We observed no significant differences in subjective outcomes when comparing patients undergoing SPARC versus MONARC sling placement in the treatment of SUI with VLPP < 60 cm H2O. A deterioration in continence rates was seen with extended follow-up. These data may be affected by low patient numbers and related study power, in particular with more extended follow-up

Long-Term Follow-up of Polypropylene Bone Anchored Slings

“…The similar success and dry rates at 1 year and 5 years of follow-up indicates a very durable effect of BAS on symptoms. Furthermore, the long-term success rates after BAS are comparable to those reported for midurethral slings (10).…”

The Role of Intrinsic Sphincteric Deficiency Diagnosis in the Era of Midurethral Sling

“…Conflicting evidence was presented by both Rapp et al [23] and Constantini et al [24]. Rapp et al [23] compared 97 women who had a SPARC procedure (retropubic midurethral sling) with 39 patients undergoing a Monarc sling.…”

“…Rapp et al [23] compared 97 women who had a SPARC procedure (retropubic midurethral sling) with 39 patients undergoing a Monarc sling. All patients had ISD with a VLPP less than 60 cm H 2 O.…”

A retrospective comparative series comparing monarc and sparc suburethral slings

“…Rapp [14] compared Monarc (n = 39) with Sparc (n = 97) slings retrospectively over 36 months for the treatment of intrinsic sphincter deficiency and found similar success rates (77% vs 76%). The lower success, compared to the current study, relates to the more difficult to treat intrinsic deficiency.…”