Transobturator SAFYRE sling is as effective as the transvaginal procedure

Abstract

Introduction: SAFYRE is a monofilament polypropylene mesh held between two self-anchoring silicone columns that associates universal approach with readjustability. This unique feature allows for comparing two different approaches, i.e., transvaginal and transobturator, using the same sling. Materials and methods: A total of 226 patients with clinical and urodynamic diagnosis of SUI underwent SAFYRE sling procedure, which was performed either by transvaginal (group 1; 126 patients) or transobturator approach (group 2; 100 patients). The mean age was 63 years, in group 1 and 61 years in group 2. Physical examination, stress and pad test and urodynamic assessment were performed before the surgery. Results: The average follow-up period was 18 months in group 1 and 14 months in group 2. There was no difference in cure rate in both groups. The mean operative time was longer (25 min) in group 1 than in group 2 (15 min) (P<0.05). Bladder injury was significative greater in transvaginal group [respectively, 12/126 (0%) versus 0/100 (0%)]. Postoperatively, 20.6% of the patients presented transient irritative voiding symptoms in group transvaginal group as opposed to 10% in transobturator group. Discussion: SAFYRE sling performed by transobturator approach is as effective as the transvaginal procedure. Fewer complications and less operative time were additional advantages of the transobturator approach

Presentation and management of major complications of midurethral slings: Are complications under‐reported?

“…Ulmsten and Petros ¢rst introduced the TVT Neurourology and Urodynamics DOI 10.1002/nau Kuuva and Nilsson [2002] 1,455 patientsTVT 24/367 6 transfusion/signif bleed (0.4%), 11 bladder perforations (0.75%), 2 vascular injury (0.1%)1 nerve injury (0.07%), 4 abscesses (0.2%) Hong et al [2003] 375 patients, TVT 5/143 1 nerve injury (0.3%), 4 hematoma (1.1%) Kobashi and Govier [2003] 140 patients, SPARC 6/6 4 transfusions (2.8%), 1 bowel perforation (0.7%), 1 hematoma (0.7%) Karram et al [2003] 350 patients, TVT 6/97 2 hematoma (0.9%), 3 nerve injury (0.9%), 1urethral erosion (0.3%) Abouassaly et al [2004] 241 patients, TVT 7/173 6 signi¢cance bleed >500 ml (2.5%), 1 hematoma (0.4%) Levin et al [2004] 313 patients, TVT 2/67 2 unrecognized blad perf (0.6%) Wang [2004] 600 patients, TVT 0/28 Tsivian et al [2004] 200 patients, TVT 1/25 1 unrecognized blad perf (0.5%) Hodro¡ et al [2005] 445 patients, SPARC 2/82 1 bowel perforation (0.2%), 1 rectus hematoma (0.2%) Hammad et al [2005] 1,459 patients, TVT 993, SPARC 466 2/121 2 urethral erosion (0.1%) Paick et al [2005] 274 patients, TVT 0/110 De Leval [2003] 107 patients, TO generic (inside-out) 0/7 Delorme et al [2004] 32 patients, Uratape 0/8 DeTayrac et al [2004] 30 patients, Uratape 1/8 1 obturator hematoma (3%) Costa et al [2004] 183 patients, Uratape 2/20 2 urethral erosion (1%) Mellier et al [2004] 94 patients, Monarc 0/3 Domingo et al [2005] 65 patients, Uratape 43, Obtape 21 1/10 1 obturator abscess (1.5%) Fischer et al [2005] 220 patients, Monarc, Serasis-TO 0/18 Spinosa and Dubuis [2005] 117 patients, ObTape 0/10 Naidu et al [2005] 96 patients, Monarc 0/12 Siegel [2005] 30 patients, ObTape 1/6 1 obturator abscess (3%) Palma et al [2005] 100 patients, SAFYRE 0/20 Krauth et al [2005] 604 patients, I-STOP 1/60 1 signi¢cant bleed (0.2%) Davila et al [2005] 200 patients, Monarc 0/13 Roumeguere et al [2005] 120 patients, Uratape 60, Obtape 60 2/38 2 unrecognized urethra inj (1.7%)…”

Comparison of retropubic vs transobturator approach to midurethral slings: a systematic review and meta-analysis

“…Only one randomized trial 14 and six out of the eleven cohort studies 5,20,25,26,29,30 reported data on reoperation secondary to long-term voiding dysfunction. Overall this outcome was rare and therefore numbers were insufficient to pool results.…”

"Sling" retropúbico e transobturatório no tratamento da incontinênca urinária de esforço

“…Palma et al 18 compared the efficacy of different Safyre surgical techniques, and did not detect any difference in terms of the cure rates, which were 92.1% using the suprapubic vaginal approach and 94% using the transobturator approach. However, the transobturator technique offered reduced time in the operating theatre and a lower rate of complications such as bladder perforation (2.3% and 0%, respectively) and postoperative urgency (20.6% and 10%, respectively).…”