Midurethral sling outcomes: tension-free vaginal tape versus Pelvilace

Abstract

We sought to compare the complications and efficacy of tension-free vaginal tape (TVT) and Pelvilace. Chart reviews and telephone questionnaires documented complications, urinary symptoms [Urogenital Distress Inventory short form (UDI-6) and Patient Global Impression of Improvement (PGII)], and re-operations. Failure was defined as PGII > or = 4 (no change or worse) or reoperation for urinary incontinence. There were 91 TVT and 22 Pelvilace slings. The TVT group had lower rates of urinary retention beyond 1 week (8% vs. 43%, p < 0.001) and reoperation for retention (1% vs. 19%, p < 0.001). Median changes in UDI-6 scores were -33.3 for the TVT group and -29.6 for the Pelvilace group (p = 0.21). Median PGII scores were 1 for the TVT group and 2 for the Pelvilace group (p = 0.024). Ten percent of the TVT group and 24% of the Pelvilace group (p = 0.095) were failures. Urinary retention was more common after Pelvilace than TVT slings. Symptomatic outcomes and failure rates were similar.

The Impact of Complications on Patients’ Assessment of the Outcome of Tension-Free Vaginal Tape Procedure

“…Voiding difficulty is another common complication after TVT. We reported voiding difficulty to occur in 11.6%; this is considerably less than reports by Shippey et al 11 who reported 40% short-term voiding difficulty. However, Freeman et al 12 reported that only 5.8% required catheterisation, and Schierlitz et al 10 reported that 8.5% had short-term catheterisation.…”

Managing female pelvic floor disorders: a medical device review and appraisal

“…Synthetic (mesh) midurethral slings are the most studied surgical treatment and the current 'gold standard' for SUI [3,86]. Although non-synthetics have reported similar success [47,[87][88][89][90][91], mesh has lower complication rates including decreased urethrolysis, urinary retention and reoperation [89][90][91][92][93][94]. In POP repair, polypropylene has demonstrated greater anatomical success during sacral colpopexy than autologous or biological materials [95][96][97].…”

The Use of Biological Materials in Urogynecologic Reconstruction

“…Shippey et al performed a retrospective cohort study with prospective follow-up of patients with polypropylene and porcine dermal slings. 17 The synthetic group had lower rates of urinary retention (8 percent versus 43 percent; p Ͻ 0.001) and reoperation for retention (1 percent versus 19 percent; p Ͻ 0.001). Failures based on subjective incontinence symptoms or reoperation for stress incontinence occurred in 24 percent of porcine dermal slings versus 10 percent of synthetic slings (p ϭ 0.10).…”

“…In contrast, Bai et al found that autologous rectus fascia slings had a higher cure rate (93 percent) compared with retropubic colposuspensions (88 percent) and synthetic slings (87 percent) 23 (Table 2). [15][16][17][18][19][20][21][22][23][24][25] A recent meta-analysis concluded that traditional slings using a variety of materials (porcine dermis, dura mata, fascia lata, vaginal wall, autologous dermis, and rectus fascia) appear to be as effective as minimally invasive slings, but have higher rates of adverse events. 26 Patients with porcine dermal slings may be at an increased risk of urinary retention and reoperation because of variation in the host response to the biological material compared with the predictable response to polypropylene mesh.…”