“Mesh free” autologous transobturator mid urethral sling placement for predominant stress urinary incontinence: A pilot study

Vasudeva, Pawan; Tyagi, Vijay; Kumar, Niraj; Yadav, Siddharth; Prasad, V. Devi; Iyer, Saumya G

doi:10.1002/nau.24599

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…According to Ford et al, the objective cure rates for TOT were 82% and 85%, respectively, in the first and fifth postoperative years, and for TVT were 87% and 85%, respectively [16]. In addition, the objective cure rate for the A-TOT technique varied between 80% and 95% [6][7][8][9][10]. In our study, the objective cure rate for the A-TOT technique was 97%, whereas the A-TVT objective cure rate was 100%.…”

Section: Discussionsupporting

confidence: 40%

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Use of autologous fascia in midurethral sling surgeries; comparison of transobtrator and retropubic ways

Ozdemir,

Çolakoglu,

Topaloğlu

et al. 2023

Ginekol Pol

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Objectives: To compare autologous transobturator-tape (A-TOT) and autologous transvaginal tape (A-TVT) surgeries in terms of effectivity and complications.Material and methods: Preoperative data, duration of the operation, complications and postoperative visual analogue scores were noted. Patients were assessed 12 months after surgery. An objective cure was defined as a negative CST and no need for reoperation due to SUI. Subjective cure was defined as a PGI-I score ≤ 2. Symptom severity and QoL were measured using the total score and the total QoL score of the ICIQ-FLUTS.Results: Retrospectively 44 patients (A-TOT:29, A-TVT:15) were enrolled in this study. Mean follow-18 months. Preoperative parameters were similar. The VAS score at the 8th hour postoperatively was higher in the A-TOT group and similar at the 24 th h (p = 0.007 and p = 0.587, respectively). Grade 3 complications according to clavien dindo were only observed in the A-TOT group. At 12 month the objective cure rates according to CST were 96.5% and 100 the subjective cure rates according to PGI-I veew 96.5% and 100%. A positive CST finding was recorded in one patient (3.3%) in the A-TOT group. Total score and total quality of life (QoL) scores on the ICIQ-FLUTS were found to be significantly improved in both groups (p = 0.001 and p = 0.001, respectively) (Tab. 4). Similar improvements were found in both groups in the overall and quality of life subscores of the ICIQ-FLUTS filling and voiding sections (p = 0.476, p = 0.315, p = 0.520, and p = 0.448, respectively). Conclusions:The A-TOT technique has objective, subjective cure, and overall complication rates comparable to those of the A-TVT technique. The use of autologous fascia provides an opportunity to avoid mesh-related complications.

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Section: Discussionsupporting

confidence: 40%

“…In addition, new TVT and TOT techniques utilizing autologous tissues instead of synthetic meshes have been published. They reported a success rate of 79-94% and lower rates of complications compared to standard MUSS [6][7][8][9][10]. Some studies have compared new modifications to conventional slings.…”

Section: Introductionmentioning

confidence: 99%

Use of autologous fascia in midurethral sling surgeries; comparison of transobtrator and retropubic ways

Ozdemir,

Çolakoglu,

Topaloğlu

et al. 2023

Ginekol Pol

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“…Despite the Uphold system and the Perigee system are not available currently. However, some similar commercial kits, self-tailored meshes, and autologous fasciae remain in use for transvaginal POP reconstruction [9][10][11][12][13][14][15][16][17][18][19][20][21]. Thus, our results could provide as a guide for perioperative consultation, even in the era of native tissue repair.…”

Section: Discussionmentioning

confidence: 90%

“…However, some self-tailored vaginal mesh [9][10][11][12] and transvaginal mesh kits, such as Calistar system (Promedon, Argentine [13,14], Surelift system (Neomedic International, Terrassa, Spain [15]), Pelvimesh system (Herniamehs, Italy [16]), and Seratom ® PA system (Seratex ® PA B2 type, Serag-Wiessner KG, Naila, Germany [17]) are still in use. In the era of native tissue repair, autologous rectus fascia or fascia lata are used for transobturator or sacrospinous fixation [18][19][20][21]. Thus, the data of predictors of clinical outcome after transvaginal mesh reconstruction should be important for preoperative consultation.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Clinical Outcome in Women with Pelvic Organ Prolapse Who Underwent Transvaginal Mesh Reconstruction Surgery

Lin

et al. 2022

Medicina

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Background and Objectives: To identify the predictors of clinical outcomes in women with pelvic organ prolapse (POP) who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation. Materials and Methods: All women with POP who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation, were reviewed. Results: Between January 2011 and May 2019, a total of 206 consecutive women were reviewed, including 68 women receiving POP reconstruction with transobturator mesh fixation and 138 women who underwent POP reconstruction with sacrospinous mesh fixation. The least experienced surgeon (hazard ratio = 804.6) and advanced stage of cystocele (hazard ratio = 8.80) were the predictors of POP recurrence, especially those women with stage 4 of cystocele. Young age (hazard ratio = 0.94) was a predictor for mesh extrusion, especially those women with age ≤67 years. Follow-up interval (odds ratio = 1.03, p = 0.02) was also an independent predictor of mesh extrusion. High maximum flow rate (Qmax, hazard ratio = 1.03) was the sole predictor of postoperative stress urinary incontinence, especially those women with Qmax ≥19.2 mL/s. Preoperative overactive bladder syndrome (hazard ratio = 3.22) were a predictor for postoperative overactive bladder syndrome. In addition, overactive bladder syndrome rate improved after surgery in the sacrospinous group (p = 0.0001). Voiding dysfunction rates improved after surgery in both sacrospinous and transobturator groups. Conclusions: Predictors of clinical outcome in women who underwent transvaginal POP mesh reconstruction are identified. The findings can serve as a guide for preoperative consultation of similar procedures.

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“…To prevent synthetic tapes’ risks while maintaining the minimally invasive nature of the transobturator surgical approach, Linder and Elliot described the autologous fascial transobturator sling [10]. However, Vasudeva et al [20] reported that utilization of this autologous transobturator sling appears to be more invasive with longer operative time, especially for obese patients or those with previous Pfannenstiel incision scars. Use of Prolene sutures for adjustment of tension seems to be short-lived, as sutures will loosen with time.…”

Section: Discussionmentioning

confidence: 99%

Transobturator Tension-Free Vaginal Flap Operation versus Synthetic Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A Prospective Randomized Study

Mahfouz,

Eid,

Elbadry

et al. 2023

Urol Int

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Introduction: Synthetic mid-urethral slings (MUSs) are the gold standard treatment for female stress urinary incontinence (SUI). Recently, there have been reports of serious adverse events with synthetic tapes such as urethral erosion, vaginal erosion, and mesh infection. Tension-free vaginal flap (TVF) operation has been proven to be successful as a natural alternative to synthetic slings. We propose our novel technique, the transobturator tension-free vaginal flap (TO-TVF), utilizing native vaginal tissue and being suspended via transobturator route. Methods: This prospective study was conducted on 72 female patients with SUI, presenting at Alexandria University Hospital. Patients were randomized into 2 groups, group 1: 37 patients subjected to TO-TVF and group 2: 35 patients to conventional transobturator tape (TOT). In TO-TVF, a rectangular vaginal wall flap is created. A polypropylene monofilament mesh is sutured to each edge of the vaginal flap. This is inserted like conventional outside-in TOT. Patients were subjected to PGI and UDI-6 questionnaires and urodynamic study before and 6 months postoperatively. Results: Both groups showed comparable and significant improvements in questionnaires. Mean operative time for TO-TVF and conventional TOT was 26.31 ± 5.2 min and 21.8 ± 3.1 min, respectively. Cure rate was 89% in group 1 and 91.4% in group 2, which was not statistically significant. No significant intraoperative complications were encountered. We had no cases of vaginal or urethral erosion in both groups. Conclusions: TO-TVF is a cost-effective, feasible, safe, and effective surgical alternative to synthetic MUS. Synthetic mesh tissue anchoring properties are maintained for better adjustment of tension. However, long-term follow-up on a large cohort of patients is still needed.

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“Mesh free” autologous transobturator mid urethral sling placement for predominant stress urinary incontinence: A pilot study

Cited by 7 publications

References 18 publications

Use of autologous fascia in midurethral sling surgeries; comparison of transobtrator and retropubic ways

Use of autologous fascia in midurethral sling surgeries; comparison of transobtrator and retropubic ways

Predictors of Clinical Outcome in Women with Pelvic Organ Prolapse Who Underwent Transvaginal Mesh Reconstruction Surgery

Transobturator Tension-Free Vaginal Flap Operation versus Synthetic Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A Prospective Randomized Study

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