Position of the Ibero‐American Society of Neurourology and Urogynecology in relation to the use of synthetic suburethral meshes for the surgical treatment of female stress incontinence

Müller-Arteaga, Carlos; Martínez, Alicia Martín; Padilla‐Fernández, Bárbara; Hernández, Pedro Blasco; Pons, Montserrat Espuña; Cruz, Francisco; Errando‐Smet, Carlos; Martínez‐García, Roberto; Palacio, Eduardo Vicente; Díaz, David Castro; Lavalle, Luís López-Fando; Patuel, B. Madurga; Cerro, Cristina Ros; Guzmán, S. Arlandis

doi:10.1002/nau.24178

Cited by 8 publications

(7 citation statements)

References 30 publications

(68 reference statements)

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“…However, the surgical technique used by those groups had not been previously described, which in our opinion is of special relevance to proper interpretation of the results. As previously stated, the recommendations of our reference guidelines [1, 8] have to be followed. However, in our opinion, it is useful to know a standardized transvaginal technique for those cases in which the TVM approach is the best option.…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, satisfactory results and a low complication rate have been obtained [7]. Since the publication of the European Urology Association/European Urogynaecological Association consensus document [1], and in accordance with the recent clinical recommendations of the Ibero-American Society of Neurourology and Urogynecology [8], we have also restricted the use of TVM in our own practice. However, we acknowledge that there are still some cases in which TVM will be the most appropriate approach.…”

Section: Introductionmentioning

confidence: 99%

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Pelvic Organ Prolapse Repair with Mesh: Description of Surgical Technique Using the Surelift® Anterior Repair System

et al. 2020

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Introduction: Although the use of transvaginal mesh (TVM) in the repair of pelvic organ prolapse (POP) has been restricted, there are still some cases in which TVM may be the most appropriate approach. The TVM Surelift® anterior repair surgical technique has not been described previously. Objective: The aim of this study was to describe the surgical technique and to report our preliminary results regarding efficacy and complications. Methods: A step-by-step description of surgical technique is presented. A descriptive retrospective analysis was performed to evaluate our preliminary results in 17 women who underwent POP repair using the Surelift® anterior repair system in our department between 2014 and 2017. TVM was offered to patients with symptomatic apical (primary or recurrent) or recurrent anterior POP stage ≥2. POP recurrence was classified as asymptomatic anatomic or symptomatic. Patients rated satisfaction with surgery on a scale from 0 to 10. Complications during follow-up were classified according to the International Urogynecological Association/International Continence Society recommendations. Results: Median (IQR) follow-up was 19.9 months (24.8). Two (11.8%) anatomic recurrences were identified, both symptomatic, but neither required further surgery. No cases of pelvic pain, dyspareunia, voiding, or defecatory dysfunction were detected. Two (11.8%) patients presented a <1-cm vaginal mesh exposure (2AaT3S2) requiring partial mesh removal through a vaginal approach. At the end of follow-up, median satisfaction (IQR) with the surgery was 9 (3.1). Conclusion: The Surelift® anterior repair system is effective in correcting apical or recurrent anterior POP, with a high patient satisfaction rate. Complications after this surgery are infrequent and are mostly related to vaginal mesh exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pelvic Organ Prolapse Repair with Mesh: Description of Surgical Technique Using the Surelift® Anterior Repair System

et al. 2020

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“…On the other hand, TOT is slightly less effective and present more postoperative short term groin pain, however, they are associated with a lower rate of lower urinary tract injury, such as bladder perforation or urethral injury. 3 Even though a lower urinary tract injury with the transobturator approach is reported to be <0.5%, one's clinical suspicion for this post-operative complication should remain high. Identification and immediate treatment of these injuries during surgery can greatly reduce all potential serious complications, such as the formation of an abnormal connection between the bladder and the vagina (vesico-vaginal fistula) or urethral erosion.…”

Section: Introductionmentioning

confidence: 99%

Urethro-cutaneous fistula: a rare complication in anti-incontinence surgery with trans-obturator tapes sling

Treviño Cavazos,

Guerrero Reyes,

Gutiérrez González

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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This case report presents a rare complication of tension-free mid-urethral tape surgery by the obturator approach (TOT) in the form of a urethro-cutaneous fistula. The patient underwent successful surgical repair, highlighting the importance of intraoperative cystoscopy to minimize surgical risks and complications. Tension-free mid-urethral tape surgery is a commonly performed procedure for the treatment of stress urinary incontinence (SUI). However, complications can occur, albeit rarely. In this case, a 52-year-old female patient developed a urethro-cutaneous fistula following TOT surgery. The fistula was identified by the presence of urine leakage at the right inguinal level, leading to significant distress and discomfort for the patient. Prompt diagnosis and appropriate management are crucial in such cases. The patient underwent surgical repair, which involved excision of the fistulous tract. The procedure was successful, resulting in complete resolution of the fistula and restoration of normal urinary function. In conclusion, this case report highlights the occurrence of a rare complication, namely a urethro-cutaneous fistula, following TOT surgery. The successful surgical repair emphasizes the importance of prompt diagnosis and appropriate management. Furthermore, the authors propose that an intraoperative cystoscopic evaluation be considered, even after a TOT procedure. Especially in cases that present risk factors or in hospital-school institutions. By implementing this practice, surgeons can enhance patient safety and improve surgical outcomes in anti-incontinence procedures.

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“…The most performed surgical procedure is midurethral sling surgery (MUSS). This surgery is performed using the retropubic approach [transvaginal tape (TVT)] or the transobturator approach (transobturator tape [TOT]) and non-tensile, non-absorbable synthetic tape to provide support under the urethra [1]. The long-term average cure rate of MUSS varies from 62 to 98% in the literature [2].…”

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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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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Position of the Ibero‐American Society of Neurourology and Urogynecology in relation to the use of synthetic suburethral meshes for the surgical treatment of female stress incontinence

Cited by 8 publications

References 30 publications

Pelvic Organ Prolapse Repair with Mesh: Description of Surgical Technique Using the Surelift<sup>®</sup> Anterior Repair System

Pelvic Organ Prolapse Repair with Mesh: Description of Surgical Technique Using the Surelift<sup>®</sup> Anterior Repair System

Urethro-cutaneous fistula: a rare complication in anti-incontinence surgery with trans-obturator tapes sling

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

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