Safety considerations for synthetic sling surgery

Blaivas, Jerry G.; Purohit, Rajveer S.; Benedon, Matthew; Mekel, Gabriel; Stern, Michael; Billah, Mubashir; Olugbade, Kola; Bendavid, Robert; Iakovlev, Vladimir V.

doi:10.1038/nrurol.2015.183

Cited by 92 publications

(79 citation statements)

References 400 publications

(664 reference statements)

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“…Regarding MUS-associated complications, the quality of studies focusing on this aspect is currently poor [10]. Consequently, the true incidence of MUS-related complications is unknown.…”

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confidence: 99%

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Retropubic versus transobturator MUS: time to revisit?

Lose

Klarskov

2017

Int Urogynecol J

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Synthetic midurethral sling (MUS) operations have become the current standard for surgical treatment of stress urinary incontinence in women. The retropubic tension-free vaginal tape was introduced by Ulmsten et al. in 1996 [1], while the transobturator technique was introduced by Delorme in 2001 [2]. Thus, we have 20 and 15 years of accumulated evidence regarding these techniques, respectively. According to the latest Cochrane systematic review [3], the retropubic and transobturator procedures are associated with similar cure rates, both subjective and objective in the short term (≤1 year), the medium term (1-5 years), and even in the long term (>5 years). The relative risks vary between 1 and 0.95.The question, however, is whether these data provide a trustworthy description of efficacy in terms of durability of the MUS placed using the two procedures. A recent study based on a complete 10-year national registry cohort of 8,671 women showed reoperation rates after 5 years for the retropubic and the transobturator approaches of 6% and 9%, respectively. A Cox regression analysis revealed that the relative risk of reoperation after the transobturator procedure was twofold higher than after the retropubic procedure, a difference that was statistically significant [4]. The strength of these results is in the robustness of the information, since data reporting is compulsory for all hospitals according to Danish law and data completeness is above 90%. Similarly, a recent report based on available National Health Service data in Scotland relating to 4,628 retropubic tape procedures and 4,850 transobturator tape procedures concluded that Bbeyond 12 months there is a substantially greater need for repeat SUI-surgery following the transobturator approach^. Consequently, only the retropubic tape procedure is recommended for the surgical treatment of stress urinary incontinence [5].Adding to the two national cohort studies the recent Cochrane review showed, that the relative reoperation rate after 1 year was 1.64 higher following the transobturator procedure, but the difference in the rates was not statistically significant. However, in the two medium-term studies and the four long-term studies the reoperation rates were 21.89 and 8.79 times higher, respectively, after the transobturator procedure, and the difference between these rates was significant [3]. All six studies pointed in the same direction. Finally, a recent systematic review and meta-analysis of retropubic versus transobturator MUS procedures in patients with Bintrinsic sphincter deficiency^showed a lower subjective cure rate in the short/medium term and a higher reoperation rate in the long term after the transobturator procedure [6]. Thus, the transobturator approach may be especially inferior in patients with a weak closure mechanism (sphincter deficiency or poor support). Thus, accumulating evidence clearly indicates that the reoperation rate is significantly higher and hence slings placed are significantly less durable with the transobturator approach th...

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“…Regarding MUS-associated complications, the quality of studies focusing on this aspect is currently poor [10]. Consequently, the true incidence of MUS-related complications is unknown.…”

mentioning

confidence: 99%

“…Consequently, the true incidence of MUS-related complications is unknown. However, the overall risk of a negative outcome has been estimated to be ≥15% [10]. The profile of morbidity after MUS seems to be different and a slightly higher after the retropubic procedure than after the transobturator procedure.…”

mentioning

confidence: 99%

Retropubic versus transobturator MUS: time to revisit?

Lose

Klarskov

2017

Int Urogynecol J

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“…[33][34][35][36][37] In patients with refractory OAB, sling excision was found to relieve the OAB symptoms in 28-64% of patients. 38 In our opinion, identifying underlying causes of OAB symptoms should occur before empiric OAB therapies begin. In fact, this is exactly what the AUA guideline panel recommended.…”

Section: Discussionmentioning

confidence: 97%

Urogynecological conditions associated with overactive bladder symptoms in women

Forde

Davila

Marks³

et al. 2017

CUAJ

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Cite as: Can Urol Assoc J 2017;11(3-4):E83-7. http://dx.doi.org/10.5489/cuaj.3962 Published online March 16, 2017 Abstract Introduction: Overactive bladder symptoms (OAB) affect 9-43% of women and are associated with underlying disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The aim of this study is to identify urogynecological conditions associated with OAB symptoms. Methods: This prospective, institutional review board-approved study included women referred to a tertiary centre with lower urinary tract symptoms (LUTS). All women completed the selfadministered OAB questionnaire (OABSS). Those with an OABSS ≥8, the cutoff, were considered to have OAB symptoms. Patients underwent a history and physical examination (including BadenWalker prolapse grading and stress test), 24-hour voiding diary, pad test (for urinary incontinence), urinalysis, and uroflow with post-void residual volume. Patients were classified clinically into the following: idiopathic OAB, SUI, POP, bladder outlet obstruction (BOO) neurogenic bladder (NGB), recurrent urinary tract infection (UTI), and miscellaneous. Results: In total, 148 women met the inclusion criteria with a mean age of 67 years. Only 27% had no comorbid conditions and were considered idiopathic OAB. Associated urogynecological conditions included SUI in 37%, POP in 26%, miscellaneous conditions in 18%, recurrent UTI in 11%, NGB in 9%, and BOO in 8%. Some patients met criteria for more than one category, thus the total is greater than 100%. Conclusions: In a tertiary care setting, a significant proportion of women with OAB symptoms have underlying conditions that may cause or contribute to their symptoms. Appropriate evaluation is desirable to enhance our understanding of the relationship of these conditions to the diagnosis, treatment, outcomes, and pathophysiology of OAB.

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“…The common complications of clinical significance after SMUS placement include vaginal mesh extrusion, vaginal scarring/stenosis, urethral and bladder perforation, voiding dysfunction, de novo urgency and urge incontinence, recurrent infections, vaginal bleeding, dyspareunia, and chronic pain, which have been discussed in multiple comprehensive reviews (9) and studies (10). Instead, we will focus on a discussion of chronic pain as a representative example of this class of complications.…”

mentioning

confidence: 99%