Adjustable single incision sling Ajust — the effects of first operations controlled by pelvic floor sonography

Abstract

Objective: The aim of this study is to evaluate using PFS-TV the mid-term results of our first operative experience with implanting a single incision sling -Ajust™. Material and methods:One and the same surgeon has operated all the patients with symptoms of stress urinary incontinence. Ajust was the only performed procedure. Postoperative evaluation consisted of: a standardized interview and examination, a cough test and a PFS-TV for evaluation of urinary continence and tape location. PFS-TV was performed under standardized conditions at rest and during maximum Valsalva maneuver.Results: This is a retrospective analysis of data from a total of 31 patients who attended a control visit between the 36 th and the 50 th month following the operation. Sixteen patients (51.6%) were cured. There were statistically significant differences in urethral mobility (p < 0.0007) and tape-urethra distance (p < 0.002) between cured and not-cured group. The difference in urethral length was not statistically significant. 77.8% of women with a hypermobile urethra was cured in contrast to 15.4% with a normobile urethra. Neither of the groups had a hypomobile urethra patient. There were no significant complications intra-or post-operatively. De novo urgency was observed in 1 patient only.Conclusions: Implantation of Ajust tape seems to be a safe mode of operative treatment for SUI in women. Our mid-term results suggest that long term effects might be worse compared to retropubic or transobturator tapes, especially at first operative experience with Ajust. Urethral mobility seems to be an important risk factor for treatment failure after Ajust implantation. It seems that patients that may benefit from Ajust most are women with urethral hypomobility but this needs to be verified with a prospective study.

Adjustable mini-sling compared with conventional mid-urethral slings in women with urinary incontinence: a 3-year follow-up of a randomized controlled trial

“…This study is one of only two evaluating the performance of Ajust® separately and one of few evaluating the performance of adjustable mini-slings as a group for periods longer than 2 years [20, 25–27]. Therefore, the comparison of our results with those of other studies presents significant difficulties.…”

“…Therefore, the comparison of our results with those of other studies presents significant difficulties. Kluz et al [20] reported recently in a retrospective design on the outcomes of Ajust® 36–50 months after the operation. The post-operative evaluation was carried out through a combination of interview and examination and the observed cure rate of 51.6% is in agreement with our results based on the ICIQ-UI-SF.…”

“…There is some evidence indicating greater cost-effectiveness compared with TVT-O [18] and Ajust® has been shown to be easier to attach to the obturator complex than other mini-slings [19]. However, most of the studies concerning Ajust® demonstrate a follow-up period of around 1–2 years, with the exception of one study analyzing 3-year results [20]. Considering the initial promising results of the Ajust® sling, Rudnicki et al published a randomized controlled trial in 2017, which was the first to compare Ajust® with SMUS other than TVT-O [21].…”