Retropubic Compared With Transobturator Tape Placement in Treatment of Urinary Incontinence

Laurikainen, Eija; Valpas, Antti; Kivelä, Aarre; Kalliola, Tuomo; Rinne, Kirsi; Takala, Teuvo; Nilsson, Carl Gustaf

doi:10.1097/01.aog.0000249607.82768.a1

Cited by 154 publications

(82 citation statements)

References 31 publications

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“…The complication rates are higher with retropubic routes than with transobturator tapes (26), although there are some studies against this conclusion (27,28,29). For instance, a randomized comparative trial suggested that patients in transobturator group had more complications than the retropubic group (27).…”

Section: Discussionmentioning

confidence: 99%

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What are the Predictive Factors of the Cure and Complication Rates for Midurethral Slings in the Treatment of Stress Urinary Incontinence in Women: A Multicenter and Multivariate Analysis Study

Çitgez¹,

Demi̇rkesen²,

Mangır³

et al. 2017

jus

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What's known on the subject? and What does the study add? Öz Amaç: Kadınlarda stres tip idrar kaçırma (STİK) tedavisinde midüretral sling (MUS) uygulanmasının sonuç ve komplikasyon oranlarını etkileyen prediktif faktörleri araştırdık. Gereç ve Yöntem: Ürodinamik STİK tespit edilip MUS uygulanan 594 kadın hasta (285 transobturator dıştan içe, 91 transobturator içten dışa, 218 retropubik) araştırıldı. Ortalama yaş 53,9 (27-82) idi. Univaryan analizde ki-kare, Student-t ve Mann-Whitney U testleri kullanıldı. Multivaryan Objective: Predictive factors that could affect the cure and complication rates of midurethral slings (MUS) in the treatment of stress urinary incontinence (SUI) were investigated. Materials and Methods: A total of 594 women (outside-in transobturator in 285, inside-out transobturator in 91, and retropubic in 218) with SUI and who had undergone MUS were evaluated. The median age was 53.9 (27-82) years. Univariate analyses were done using chi-square test, Student's t-test and the Mann-Whitney U test. Multivariate analyses were done using logistic regression analysis to determine predictive factors affecting cure and complication rates. Results: The mean follow-up time was 48 months. The subjective cure rate was 84% and complication rate was 11.2%. On univariate and multivariate analyses, the cure rate was found to be increased in younger patients [odds ratio (OR): 0.97, 95% confidence interval (CI): 0.95-0.99, p=0.038] and in patients with pure SUI (OR: 2.17, 95% CI: 1.31-3.60, p=0.002). The type of surgery was the only statistically significant parameter affecting the complication rate, which was significantly higher in retropubic MUS procedure (OR: 6.28, 95% CI: 3.51-11.22, p<0.001). Conclusion: MUS is an effective and safe surgical procedure in the treatment of SUI. In this study, age and type of incontinence were the only significant predictive factors affecting the cure rate. Our study suggests that retropubic approach could be considered a risk factor for complication after MUS.

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Section: Discussionmentioning

confidence: 99%

“…For instance, a randomized comparative trial suggested that patients in transobturator group had more complications than the retropubic group (27). However, in another study, it was demonstrated that TOT was equally effective as TVT with fewer complication, and the authors suggested that TOT would be the procedure of choice (30).…”

Section: Discussionmentioning

confidence: 99%

What are the Predictive Factors of the Cure and Complication Rates for Midurethral Slings in the Treatment of Stress Urinary Incontinence in Women: A Multicenter and Multivariate Analysis Study

Çitgez¹,

Demi̇rkesen²,

Mangır³

et al. 2017

jus

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“…Depending on the definition used to define cure, the objective and subjective cure rates appear to be statistically similar with all sling modalities for the uncomplicated patient with stress incontinence. [5][6][7][8][9][10] There does, however, appear to be a significant difference in complications between the approaches. The retropubic approach demonstrates an increased risk of intraoperative bladder perforations, de novo urgency and storage lower urinary tract symptoms (LUTS), while transobturator routes show an increased risk of vaginal erosion and groin pain.…”

Section: Short-and Long-term Outcomesmentioning

confidence: 99%

Choosing the right sling for your patient

Steele

Bailly

2017

CUAJ

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Recent data has demonstrated a one in five lifetime risk of a woman requiring stress urinary incontinence (SUI) surgery. Currently, most women opt for a synthetic midurethral sling (MUS), with over 3.6 million placed worldwide. This article attempts to identify whether a gold standard exists with regards to surgical correction of female SUI.When considering which sling type to use for which incontinent woman, the published data demonstrates excellent results for both synthetic mesh (retropubic or transobturator routes) and fascial pubovaginal slings for most patients. Intrinsic sphincter deficiency does appear to be better treated with the use of a retropubic approach, although still with less than stellar results. With little to differentiate, the treatment of most female SUI may be solely based on which sling the surgeon feels most comfortable performing. Currently, most urologists and gynecologists favour synthetic MUS over fascial slings in surgical-naïve patients; however, recent U.S Food and Drug Administration (FDA) warnings concerning the use of mesh in transvaginal surgery have patients questioning the safety of synthetic MUS for the treatment of SUI.

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“…Bu nedenle ,literatüre katkı sağlaması amacıyla, kendi kliniğimizde asistanların uzman eşliğinde yaptığı midüret-ral slingleri komplikasyon ve tedavi oranları açısından inceledik. Midüretral sling operasyonlarında kanama insidansı tanıma bağlı değişmekle birlikte, TVT sonrası %0.7-8 arasında [14,15], TOT sonrası ise %0-2 arasında bildirilmiştir [16,17].Bizim çalış-mamızda, 91 TVT yapılan hastanın 3(%3.3) ünde transfüzyon gerektiren kanama izlenirken, 50 TOT yapılan hiçbir hastada transfüzyon gerektiren kanama izlenmedi. TVT yapılan ve transfüzyon gerektiren 3 hastadan birinde, postoperatif 4.saatte kanama nedeniyle laparotomi yapıldı.…”

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“…Bu nedenle, TVT yapılan hastalar postoperatif erken dönemde korona mortis ve majör damar yaralanmaları açısından yakından izlenmelidir. Literatürde, mesane perforasyonu insidansı TVT için %0.7-34.2 arasında [14,21], TOT için %0-3.1 [22,23] olarak bildirilmiştir. Bizim çalışmamızda, mesane perforasyonu insidansı TVT için %5.5(5/91) iken, TOT yapılan 50 hastada hiç mesane perforasyonu izlenmemiştir.…”

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Effect of Resident Performance on Midurethral Sling Cure and Complication Rates

Cavkaytar¹,

Kokanali²,

Iskender³

et al. 2015

Ann Clin Anal Med

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ÖzetAmaç: Asistanların uzman eşliğinde yaptığı midüretral slingleri komplikasyon ve tedavi oranları açısından incelemek. Gereç ve Yöntem: Ocak 2013 ve Ocak 2014 tarihleri arasında Ankara Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi Ürojinekoloji Kliniği'nde yapılan üriner stres inkontinans nedeni ile yapılan 141 midüretral sling ameliyatı değerlendirmeye alın-dı. Hastaların yaşı, parite, vücut kitle indeksi, menopoz durumu, preoperatif >2.derece POP varlığı, eşlik eden vajinal cerrahi gibi özellikleri ile intraoperatif (mesane ve bağırsak zedelenmesi, kanama, vajinal laserasyon ) ve erken postoperatif (idrar retansiyonu vb) komplikasyonlar kaydedildi. Postoperatif 6. ayda, bütün hastalar tekrar muayene edildi ve semptomlar konusunda sorgulandı. Stres testi negatif olup düzeldiğini belirtenler ''iyileşmiş'', inkontinans sıklığı azalmakla beraber halen devam edenler '' kısmi iyileşmiş'' ve inkontinans şikayetlerinde değişiklik olmayanlar '' başarısız'' olarak sınıflan-dırıldı. Hem TVT , hem de TOT grubu komplikasyonlar ve tedavi oranları açı-sından karşılaştırıldı. Bulgular: Saf stres üriner inkontinans nedeniyle midü-retral sling operasyonu uygulanan 141 hastadan, 50(%35.5) tanesinde TOT, 91(%64.5) tanesinde ise TVT uygulandı. TVT grubunda 3 (%3.3) hastada kan transfüzyonu gerektiren postoperatif kanama ve 5 (%5.5) hastada mesane perforasyonu izlendi. Buna karşın TOT grubundaki hastalarda postoperatif ciddi kanama ve mesane perforasyonu gözlenmedi. Postoperatif erken dö-nemde TOT operasyonu sonrası 7 (%14.0) hastada, TVT operasyonu sonrası ise 17 (18.7) hastada üriner retansiyon gelişti. TOT ve TVT uygulanan hastalar, intraoperatif ve postoperatif erken komplikasyonların sıklığı bakımın-dan istatistiksel olarak benzerdi. Postoperatif 6. ayda TOT uygulanan hastaların % 76 sı iyileşmiş, % 18 i kısmi iyileşmiş iken % 6sında operasyon başarısız iken, TVT uygulanan hastalar için bu sonuçlar sırası ile % 83.5, %12.1 ve %4.4 idi ve istatistiksel olarak fark yoktu. Tartışma: Asistanların tecrübeli cerrahların gözetiminde yaptığı midüretral slinglerin başarı ve majör komplikasyon oranları literatürle uyumludur. Minör komplikasyon oranları biraz yük-sek gözükse de, tedavi başarısı ve hasta memnuniyetini etkilememektedir. Anahtar KelimelerÜriner İnkontinans; Midüretral Sling; Asistan; Komplikasyon Abstract Aim: To evaluate the cure rates and complications of midurethral slings performed by residents under an experienced surgeon supervision. Material and Method: Between January 2013 and January 2014, one hundred forty-one midurethral slings performed in the urogynecology clinic of Ankara Zekai Tahir Burak Women's Health Research and Education Hospital were reviewed.Age, parity,body mass index,menopausal status, grade 2 preoperative pelvic organ prolapsus,concomitant vaginal surgery and intraoperative (bladder and bowel perforations,bleeding,vaginal laceration) and early postoperative (urinary retention etc.)complications were recorded.All women were re-examined at postoperative 6 th month and symptoms were q...

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Retropubic Compared With Transobturator Tape Placement in Treatment of Urinary Incontinence

Abstract: I.

Cited by 154 publications

References 31 publications

What are the Predictive Factors of the Cure and Complication Rates for Midurethral Slings in the Treatment of Stress Urinary Incontinence in Women: A Multicenter and Multivariate Analysis Study

What are the Predictive Factors of the Cure and Complication Rates for Midurethral Slings in the Treatment of Stress Urinary Incontinence in Women: A Multicenter and Multivariate Analysis Study

Choosing the right sling for your patient

Effect of Resident Performance on Midurethral Sling Cure and Complication Rates

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