Retropubic and Transobturator Slings: Still Useful or Should All Patients Be Treated with Mini-slings?

Kennelly, Michael; Myers, Erinn M.

doi:10.1007/s11934-011-0200-6

Cited by 3 publications

(4 citation statements)

References 39 publications

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“…The Ajust sling is one of the single-incision vaginal slings that appeared on the market in 2009 [ 5 ]. Its puncture method is to use a specially designed anchor to fix the sling on the obturator membrane without letting both ends penetrate through the skin.…”

Section: Discussionmentioning

confidence: 99%

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Meta-analysis of female stress urinary incontinence treatments with adjustable single-incision mini-slings and transobturator tension-free vaginal tape surgeries

et al. 2015

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BackgroundThe study on SIMS and SMUS as a whole by Alyaa Mostafa et al showed that after excluding the TVT-S sling, there is no significant difference in patient-reported cure rate and objective cure rate between these two methods. In this paper, we systematically evaluate the relevant data on SIMS-Ajust and TVT-O/TOT and further confirm their safety and effectiveness, providing reliable clinical evidence.MethodsBy searching the Medline, Embase, Scopus, and Web of Science databases and the Cochrane Database of Systematic Reviews combined with manual searches, all reports on randomized controlled trials (RCTs) of single-incision mini-sling (SIMS-Ajust) and transobturator tension-free vaginal tape (TVT-O/TOT) surgeries were collected. Using RevMan 5.2 statistical software, the patient-reported cure rate, objective cure rate, operative time, postoperative pain, lower urinary tract injuries, groin pain, postoperative voiding difficulties, de novo urgency and/or worsening of preexisting surgery, vaginal tape erosion, repeated continence surgery, and other related data on both surgical methods were evaluated.ResultsA total of 154 relevant research reports were retrieved, and five randomized controlled trials were included in this study, involving a total of 678 patients. The meta-analysis results show no significant difference in the patient-reported cure rate and objective cure rate between SIMS-Ajust and TVT-O/TOT [RR = 0.95, 95 % CI (0.87 to 1.04), P > 0.05; RR = 0.97, 95 % CI (0.90–1.05), P > 0.05]. With respect to operation time and groin pain, SIMS-Ajust outperforms TVT-O/TOT [MD = −1.61, 95 % CI (−2.48 to 0.74), P < 0.05; RR = 0.30, 95 % CI (0.11 to 0.85), P < 0.05]. In terms of postoperative pain, lower urinary tract injuries, postoperative voiding difficulties, de novo urgency and/or worsening of preexisting surgery, vaginal tape erosion, and repetition of continence surgery, there is no significant difference between SIMS-Ajust and TVT-O/TOT [RR = 0.50, 95 % CI(0.18–1.43), P > 0.05; RR = 2.82, 95 % CI(0.14–57.76), P > 0.05; RR = 0.64, 95 % CI(0.28–1.45), P > 0.05; RR = 1.06, 95 % CI(0.66–1.71), P > 0.05; RR = 1.04, 95 % CI(0.24–4.45), P > 0.05; RR = 1.64, 95 % CI(0.41–6.61), P > 0.05].ConclusionsSIMS-Ajust is safe and effective in the treatment of female stress urinary incontinence. Compared with TVT-O/TOT surgery, SIMS-Ajust surgery has the same high objective cure rate and patient-reported cure rate and low incidence of perioperative complications, in addition to its short operative time and low incidence of groin pain. Its long-term efficacy needs further observation.

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Section: Discussionmentioning

confidence: 99%

“…The SIMS-Ajust sling is a novel single-incision sling that appeared on the market in 2009 [ 5 ]. The patient-reported cure rate of SIMS-Ajust is between 73.9 % and 81.2 %, and its objective cure rate is between 76.8 % and 84.7 % [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of female stress urinary incontinence treatments with adjustable single-incision mini-slings and transobturator tension-free vaginal tape surgeries

et al. 2015

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“…However, our result is comparable to the 81% to 90.3% reported by other studies. 4 , 6 , 22 , 23 , 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 , 9 , 10 , 11 , 12 Although TOT has been reported to be a safe and cost-effective method, its success rate remains questionable. 4 , 6 , 8 , 13 , 14 , 15 To improve the success rate of TOT procedures, our intraoperative test was performed before application and adjustment of the mesh to control the tension of the tape after observing the degree and pattern of urine leakage. We studied whether this method had an effect on the success rate of TOT procedures.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Observation of the Degree and Pattern of Urine Leakage before Adjustment of the Mesh during a Transobturator Tape Procedure

2014

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Most intraoperative provocative tests previously reported were performed after mesh adjustment to confirm the absence of urine leakage. Instead, our test was performed before adjustment of the mesh to control the tape tension after observing the pattern of the urine leakage. We studied whether this method had an effect on the success rate of transobturator tape (TOT) procedures. A total of 96 patients were included: 47 patients underwent TOT procedures without intraoperative testing (Group I) and 49 patients underwent TOT procedures with testing (Group II). Bladder filling was performed with at least 300 ml of normal saline during the test. After observing the pattern of the urine leakage before adjustment of the mesh by coughing or manual pressure on the suprapubic area, we controlled the mesh tension. In Group I, which did not undergo the intraoperative test, the Valsalva leak-point pressure, cough leak-point pressure, preoperative and postoperative peak flow velocity (Qmax), and postvoiding residual urine (PVR) were 86.46 cmH2O, 101.91 cmH2O, 20.82 ml/s, 22.74 ml/s, 19.77 ml, and 45.98 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.92 ml/s and 26.21 ml, respectively. In Group II, in which the test was applied, the corresponding results were 85.50 cmH2O, 100.45 cmH2O, 25.60 ml/s, 26.90 ml/s, 17.16 ml, and 29.67 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.3 ml/s and 12.51 ml, respectively. The two groups showed no significant differences in any of the variables. In Group I, the cure and improvement rates were 70.2% and 27.7%, respectively. In Group II, the rates were 91.8% and 8.2%, respectively. Group II had a significantly higher success rate than Group I (p value= 0.011). In the univariable logistic regression analysis, Group II exhibited a higher odds ratio (4.771) than Group I in terms of cure rate, and Group II had a higher success rate than Group I (p value=0.011). In the multivariable logistic regression analysis, Group II exhibited a higher odds ratio (4.700) than Group I in terms of cure rate under calculation of the variables (namely, age, hypertension, preoperative Qmax, and PVR), and the cure rate of Group II was verified to be significantly higher than that of Group I (p value=0.019). We suggest that our test is an effective method to confirm whether adequate tension is being applied to the tape. Our method presents some advantages in that surgeons can control and adjust the tension of the mesh after observing the degree and pattern of the urine leakage.

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Mini-Slings: Unique Issues

Bastawros

Kennelly

2017

Complications of Female Incontinence and Pelvic Reconstructive Surgery

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Retropubic and Transobturator Slings: Still Useful or Should All Patients Be Treated with Mini-slings?

Cited by 3 publications

References 39 publications

Meta-analysis of female stress urinary incontinence treatments with adjustable single-incision mini-slings and transobturator tension-free vaginal tape surgeries

Meta-analysis of female stress urinary incontinence treatments with adjustable single-incision mini-slings and transobturator tension-free vaginal tape surgeries

Intraoperative Observation of the Degree and Pattern of Urine Leakage before Adjustment of the Mesh during a Transobturator Tape Procedure

Mini-Slings: Unique Issues

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