Prospective comparison of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence

Abstract

Laparoscopic colposuspension is an effective method for the treatment of GSI, as documented by anatomical and functional assessments. However, the success rate is still lower than for the traditional procedure.

Laparoscopic colposuspension: a systematic review

“…When analysis was performed excluding Su et al's study 12 , the cure rate was still lower for laparoscopic compared with open colposuspension, but not significantly so (RR 0.91, 95% CI 0.82 to 1.01) with an additional 8% of failure for laparoscopic compared with open colposuspension (RD À0.08, 95% CI À0.15 to 0.00).…”

“…The mean pad test leakage improved in both groups initially, but a similar decline could be observed. In Fatthy et al's study 11 12 from the analysis, the risk was 9% higher (RD 0.09, 95% CI À0.03 to 0.21) (RR 1.93, 95% CI 0.78 to 4.78). A slightly lower, but not significantly so, incidence of de novo detrusor instability (RR 0.92, 95% CI 0.43 to 1.98) 9 -12 and voiding dysfunction (RR 0.95, 95% CI 0.37 to 2.44) 9,10 was observed in the open compared with the laparoscopic group.…”

“…In all studies, the estimated blood loss was higher in the open compared with the laparoscopic group (range: open 132 -260 mL, laparoscopic 43 -190 mL). In three studies 9,10,12 , the duration of catheterisation was longer after open than after laparoscopic colposuspension (range: open 1.7-6.8 days, laparoscopic 1.3-4.4 days), but similar for both procedures in one 13 . In Burton's study, no woman was lost to follow up after six months, but after five years, six women were lost in the open and seven in the 14 , the other compared sutures to mesh and staples 15 (Table 3).…”

“…Four trials comparing laparoscopic with open colposuspension were of good quality except for this inadequate power 9 -11,13 . In addition, Burton's study had confounding factors of not only using absorbable sutures (because nonabsorbable sutures were not available at the time of the study), but also of only having carried out a relatively small number of laparoscopic colposuspensions (<20) before commencing his trial (as opposed to two of the other trials 10,12 where the surgeons had performed more than 50 laparoscopic colposuspensions before starting the trial). These factors may have influenced his results, in particular, as there is believed to be a definite relatively steep and long learning curve associated with laparoscopic colposuspensions.…”

Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure

“…Other investigators report a mean surgical time ranging between 22 and 42 min for TVT (4,8,10,11,18). For laparoscopic colposuspension, surgical times of 49-110 min are reported (15,(19)(20)(21)(22). To account for different expertise among gynecologists performing one or the other procedure, and for different charges for anesthesia, we performed sensitivity analyzes.…”