Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis

Schimpf, Megan O.; Rahn, David D.; Wheeler, Thomas L.; Patel, Minita; White, Amanda B.; Orejuela, Francisco J.; El-Nashar, Sherif A.; Margulies, Rebecca U.; Gleason, Jonathan L.; Aschkenazi, Sarit; Mamik, Mamta M.; Ward, Renée M; Balk, Ethan M; Sung, Vivian W.

doi:10.1016/j.ajog.2014.01.030

Cited by 192 publications

(168 citation statements)

References 105 publications

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“…While MUS has a high success rate, 5-20% of the patients will have persisting incontinence thus needing to undergo sling removal and subsequent treatment [9]. The postoperative complications reach as high as 7.2% for erosion and the risk of getting a perioperative urinary tract infection is 17.2% [10]. As an alternative to MUS implantation, with the goal of targeting the underlying etiology rather than relieving the symptoms, cell-based therapies (CBTs) have recently emerged [11].…”

Section: Aimmentioning

confidence: 99%

“…Morbidities such as mesh erosion, recurrent SUI, de novo urge incontinence and urinary retention requiring release included in this model are based on formerly published studies. Within 1 year of MUS surgery, the probability of mesh erosion was 2.24%, and 84.6% had sling excision following mesh erosion [10,24]. Conservative treatment was modeled as an alternative to sling excision with an estimated base case of 15.4%.…”

Section: Probabilitiesmentioning

confidence: 99%

“…future science group www.futuremedicine.com Probability of mesh erosion following MUS surgery 2.24% [24] Probability of mesh erosion that requires sling revision/excision 84.6% [24] Probability of cure after sling revision/excision 15.4% [24] Probability of SUI after sling revision/excision 36% [25] Probability of sustained SUI after MUS surgery 9.3% Estimated Probability of reoperation with MUS due to sustained SUI 2.4% [6] Probability of having de novo urge incontinence after insertion of MUS 6.4% [26] Probability of receiving anticholinergic medicine as treatment of de novo urge incontinence 16.5% [10] Probability of urinary retention after MUS insertion that requires release 6.01% [10] Probability of persistent SUI after sling release 13% [27] Probability of cure with IVM 68.4% [16,18,28] Probability of persistent SUI after treatment with IVM 31.6% [16,18,28] Probability of cure with MM 25% [15] Probability of persistent SUI after treatment with MM 75% [15] IVM: In vitro myoblast approach; MM: Minced myofiber approach; MUS: Midurethral sling; SUI: Stress urinary incontinence. Health utility value of no incontinence 0.93 [29] Health utility value for SUI 0.71 [29] Health utility value for treatment of de novo urge with anticholinergic medication 0.81 [29] Health utility value for de novo urge after MUS operation 0.74 [29] Health utility value for repeated MUS operation 0.89 [23,29] MUS: Midurethral sling; SUI: Stress urinary incontinence.…”

Section: Probabilitiesmentioning

confidence: 99%

“…Additionally, it was modeled that 36% of the patients who had sling excision experienced persistent SUI based on a retrospective cohort study [25]. Base case rates of developing de novo urge after initial treatment with MUS and postoperative use of anticholinergic medication when having developed urge symptoms as a consequence of MUS, was modeled after an RCT, which reported probabilities of 6.4 and 16.5%, respectively [10,26]. Patients who developed urinary retention after MUS treatment that required sling release were estimated to 6.01% in base case [10].…”

Section: Probabilitiesmentioning

confidence: 99%

“…Base case rates of developing de novo urge after initial treatment with MUS and postoperative use of anticholinergic medication when having developed urge symptoms as a consequence of MUS, was modeled after an RCT, which reported probabilities of 6.4 and 16.5%, respectively [10,26]. Patients who developed urinary retention after MUS treatment that required sling release were estimated to 6.01% in base case [10]. Rardin et al performed a retrospective study investigating the risk of recurrent SUI after conducting a necessary sling release in which 13% reported having a recurrence of SUI equal to or worse than the initial baseline [27].…”

Section: Probabilitiesmentioning

confidence: 99%

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Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

et al. 2018

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Aim:To perform an early cost-effectiveness analysis of in vitro expanded myoblasts (IVM) and minced myofibers versus midurethral slings (MUS) for surgical treatment of female stress urinary incontinence. Methods: Cost-effectiveness and sensitivity analyses were performed using a decision tree comprising previously published data and expert opinions. Results & conclusion: In the base case scenario, MUS was the cost-effective strategy with a negative incremental cost-effectiveness ratio compared with IVM and a positive incremental cost-effectiveness ratio compared with minced myofibers. However, the sensitivity analysis indicates that IVM may become an alternative providing greater effect at a higher cost. With the possibility of becoming more effective, IVM treatment would be advantageous over MUS given its reduced invasiveness and lower risks of complications. Urinary incontinence (UI) is a common medical condition that has a negative impact on the quality of life of individuals of all ages, racial and ethnic groups. The prevalence of UI is about two-to-four-times higher in women than in men, ranging from 11 to 57% [1]. The most common subtype is stress urinary incontinence (SUI), affecting roughly 50% of any women with UI [2]. SUI describes a condition where there is an involuntary leak of urine when intra-abdominal pressure rises, for example, when coughing, sneezing, laughing or during other physical activity. SUI has not only a severe impact on quality of life but it also places a substantial economic burden on the healthcare system and society [3][4][5]. In the USA, for example, it has been estimated that in 1998, the average direct medical cost of SUI amounted US$5642 per patient, while the indirect workplace expenses were US$4208 [3]. Evidence suggests that these costs have experienced an age-related increase over the last years [5].The clinical management of SUI is complex and may involve conservative treatments, such as pelvic floor muscle training and pharmacotherapy, as well as surgical procedures. Currently, the gold standard for surgical management of SUI in women is the midurethral sling (MUS), which displays a cure rate of 80-95% [6][7][8]. While MUS has a high success rate, 5-20% of the patients will have persisting incontinence thus needing to undergo sling removal and subsequent treatment [9]. The postoperative complications reach as high as 7.2% for erosion and the risk of getting a perioperative urinary tract infection is 17.2% [10]. As an alternative to MUS implantation, with the goal of targeting the underlying etiology rather than relieving the symptoms, cell-based therapies (CBTs) have recently emerged [11]. Among the different modalities of CBT, intraurethral injection of autologous skeletal myoblasts appears as one of the most promising regenerative therapies for SUI [12]. While various large-scale clinical trials are still ongoing, results from the initial clinical studies have shown that these approaches appear to be safe and moderately effective. Remarkably, a recent study has shown ...

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Section: Aimmentioning

confidence: 99%

Section: Probabilitiesmentioning

confidence: 99%

Section: Probabilitiesmentioning

confidence: 99%

Section: Probabilitiesmentioning

confidence: 99%

Section: Probabilitiesmentioning

confidence: 99%

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Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

et al. 2018

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Urinary Incontinence in Women

Lukacz

Santiago‐Lastra

Albo

et al. 2017

JAMA

327

222

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Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.

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Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience

Perrouin‐Verbe,

Ochoa,

Skews

et al. 2024

BJUI Compass

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ObjectiveThe objective of this study is to describe a standardised technique of full TOT removal with groin dissection and to report clinical improvement, satisfaction, safety and long‐term functional, quality of life (QoL) and sexual QoL outcomes.Materials and methodsA retrospective review enrolling all women who had full TOT removal, in a tertiary referral centre from May 2017 to November 2020. Functional outcomes, satisfaction and QoL were assessed using a bespoke composite questionnaire (UDI‐6, EQ‐5D‐5L and ICIQ‐S) with additional questions on sexual QoL. Secondary outcomes were post‐operative recurrent stress urinary incontinence (SUI) and complication rate according to the Clavien‐Dindo classification.ResultsFull TOT removal using a vaginal approach and bilateral groin/para‐labial incisions was performed in 67 patients. Chronic pelvic pain was the main indication for mesh removal (51% of cases, n = 34). QoL questionnaires were answered by 43 patients. The satisfaction rate was high 86% (n = 37), and 81% (n = 35) of the patients considered the surgery successful. Seventy per cent (n = 30) of patients returned to having a sexual life after surgery. Recurrent SUI was reported in 32% (n = 14) of cases. The complication rate was 10% (7/67), all of them Clavien–Dindo ≤2.ConclusionDespite a high rate of postoperative bothersome SUI, full TOT removal with bilateral groin dissection improves pain and QoL. It is associated with a high overall satisfaction rate and an acceptable rate of complications.

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Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis

Cited by 192 publications

References 105 publications

Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

Urinary Incontinence in Women

Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience

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