Mid-urethral sling operations for stress urinary incontinence in women

Abstract

Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have a good safety profile. Irrespective of the routes traversed, they are highly effective in the short and medium term, and accruing evidence demonstrates their effectiveness in the long term. This review illustrates their positive impact on improving the quality of life of women with SUI. However, a brief economic commentary (BEC) identified three studies suggesting that transobturator may be more cost-effective compared with retropubic. Fewer adverse events occur with employment of a transobturator approach with the exception of groin pain. When comparing transobturator techniques of a medial-to-lateral versus a lateral-to-medial insertion, there is no evidence to support the use of one approach over the other. However, a bottom-to-top route was more effective than top-to-bottom route for retropubic tapes.A salient point illustrated throughout this review is the need for reporting of longer-term outcome data from the numerous existing trials. This would substantially increase the evidence base and provide clarification regarding uncertainties about long-term effectiveness and adverse event profile.

Retropubic versus transobturator MUS: time to revisit?

“…However, in the two medium-term studies and the four long-term studies the reoperation rates were 21.89 and 8.79 times higher, respectively, after the transobturator procedure, and the difference between these rates was significant [3]. All six studies pointed in the same direction.…”

“…Thus, we have 20 and 15 years of accumulated evidence regarding these techniques, respectively. According to the latest Cochrane systematic review [3], the retropubic and transobturator procedures are associated with similar cure rates, both subjective and objective in the short term (≤1 year), the medium term (1-5 years), and even in the long term (>5 years). The relative risks vary between 1 and 0.95.…”

Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

“…Currently, the gold standard for surgical management of SUI in women is the midurethral sling (MUS), which displays a cure rate of 80-95% [6][7][8]. While MUS has a high success rate, 5-20% of the patients will have persisting incontinence thus needing to undergo sling removal and subsequent treatment [9].…”

“…In this group, any other MUS problem is included to meet the assumptions of the decision model. After failed MUS, 2.4% were found to receive a second MUS according to Ford et al [6]. Cure rate probabilities for IVM were estimated based on three different studies.…”

“…future science group www.futuremedicine.com Probability of mesh erosion following MUS surgery 2.24% [24] Probability of mesh erosion that requires sling revision/excision 84.6% [24] Probability of cure after sling revision/excision 15.4% [24] Probability of SUI after sling revision/excision 36% [25] Probability of sustained SUI after MUS surgery 9.3% Estimated Probability of reoperation with MUS due to sustained SUI 2.4% [6] Probability of having de novo urge incontinence after insertion of MUS 6.4% [26] Probability of receiving anticholinergic medicine as treatment of de novo urge incontinence 16.5% [10] Probability of urinary retention after MUS insertion that requires release 6.01% [10] Probability of persistent SUI after sling release 13% [27] Probability of cure with IVM 68.4% [16,18,28] Probability of persistent SUI after treatment with IVM 31.6% [16,18,28] Probability of cure with MM 25% [15] Probability of persistent SUI after treatment with MM 75% [15] IVM: In vitro myoblast approach; MM: Minced myofiber approach; MUS: Midurethral sling; SUI: Stress urinary incontinence. Health utility value of no incontinence 0.93 [29] Health utility value for SUI 0.71 [29] Health utility value for treatment of de novo urge with anticholinergic medication 0.81 [29] Health utility value for de novo urge after MUS operation 0.74 [29] Health utility value for repeated MUS operation 0.89 [23,29] MUS: Midurethral sling; SUI: Stress urinary incontinence.…”