Double opposite tape incision for obstructive sling.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence affects about 34% of all adult women. The mid-urethral sling (MUS), considered the gold-standard treatment, has widespread use but also potential complications. This study aims to demonstrate a new surgical technique that releases urethral obstruction caused by MUS with urinary continence maintenance. METHODS: This video presents a 43-year-old patient with acute urinary retention after a suburethral sling procedure treated with a double opposite tape incision through a "U"-shaped inverted incision at the anterior vaginal wall. RESULTS: The patient resumed her usual activities 1 week later with urinary continence. After 6 weeks, she was allowed to resume physical activities and sexual intercourse. At 3-month follow-up, she is still satisfied without urine leakage recurrence. CONCLUSIONS: The double opposite tape incision is feasible and effective for urethral loosening after the MUS procedure. Concerned that this is a unique case, further studies are required to compare this technique to other surgical treatment options.

A low cost artisan tension-free tape technique cures pelvic organ prolapse and stress urinary incontinence - proof of concept.

INTRODUCTION: The primary cause of pelvic organ prolapse (POP) is weak cardinal/uterosacral (CL/USL) ligaments and for stress urinary incontinence, weak pubourethral ligaments (PUL). MATERIAL AND METHODS: A 1 cm wide tape cut from a mesh sheet was applied tension-free to reinforce already plicated CL/USLs for cure of prolapse and directly to PUL for cure of stress urinary incontinence (SUI). 40 tapes were inserted, 10 midurethrally for SUI and 30 for 2nd/3rd degree prolapse: 15 to uterosacral ligaments and 15 to cardinal ligaments. RESULTS: At 12 months follow-up there was 72% cure for POP, 70% for SUI and improvement in urge/nocturia symptoms in 82% of patients.At 36 months 8/15 patients were evaluated. Anatomic cure for POP III was 2/4, for POP I-II 6/6. CONCLUSIONS: Though a 'proof of concept' study, our results may be sufficient to provide, in time, an alternative individual pathway for surgeons wishing to provide more certainty to a prolapse repair than 'native tissue' for an individual patient. The method questions whether expensive mesh kits are really necessary: our data though small, actually part of a learning curve, was within 15 percentage points of more sophisticated, more expensive tensioned slings. Intraoperative complications were low with no tape erosions seen at 12 months. Further validation with larger prospective and comparative trials is required.

Randomized controlled trial comparing single-incision mini-sling and transobturator midurethral sling for the treatment of stress urinary incontinence: 3-year follow-up results.

BACKGROUND: The role of single-incision mini-slings (SIMS) in stress urinary incontinence (SUI) management is still not elucidated. OBJECTIVE: To compare efficacy and safety of SIMS and transobturator sling (TOT) for SUI after 36-month follow-up. METHODS: A randomized controlled clinical trial involving 130 women with SUI that had either SIMS or TOT. Primary outcomes: objective cure defined as negative cough stress and pad tests, and subjective cure reported as satisfaction and no desire for additional treatment. SECONDARY OUTCOMES: quality-of-life by IQOL and UDI-6 questionnaires, complications and reoperation rates. Student's t, χ2 , Fisher's exact, and Mann-Whitney tests, ANOVA and P < 0.05 as cut-off point were used for statistics. RESULTS: A total of 82 patients (n:41 each arm) completed 36-month follow-up. Objective cure was lower in the SIMS compared to TOT groups by both per protocol (68.3% and 90.2%, respectively, P = 0.027) and intention-to-treat analysis considering missing data as failures (40.6% and 60.7%, respectively, P = 0.035), while similar in both groups (81.2% and 93.4%, respectively) considering missing data as successes. Subjective cure rates were similar for both groups. TOT group presented better outcome regarding the avoidance and limiting behavior domain of IQOL (P = 0.021), and UDI-6 scores (P = 0.026). Seven out of 69 (10.1%) women in the SIMS group compared with two out of 61 (3.3%) in the TOT group (P = 0.172) had repeat surgery due to recurrent SUI at year follow up. CONCLUSION: TOT was associated to higher objective cure rate than SIMS for SUI treatment although satisfaction rate was similar for both groups 3 years postoperative.

Surgical treatment for stress urinary incontinence in women: A systematic review and meta-analysis / Tratamento cirúrgico da incontinência urinária de esforço em mulheres: revisão sistemática e metanálise

Abstract Objective To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. Data Sources We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. Selection of Studies Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. Data Collection Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. Data Synthesis Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39- 0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. Therewas no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. Conclusion Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.

Resumo Objetivo comparar tratamentos cirúrgicos para incontinência urinária de esforço (IUE), quanto à eficiência e complicações, por meio de revisão sistemática seguida de metanálise. Fonte dos dados Fizemos busca nas bases de dados MEDLINE e COCHRANE, utilizando os termos stress urinary incontinence, surgical treatment for stress urinary incontinence e sling. Seleção dos estudos Selecionamos 48 estudos, totalizando 6.881 pacientes com pontuação igual ou maior do que 3 na escala de Jadad. Coleta de dados Cada estudo foi lido por um autor, colocado em tabela, e checado por outro autor. Extraímos dados como detalhes das intervenções, tempo de seguimento, resultados do tratamento e eventos adversos. Síntese dos dados Não houve diferença nas comparações: sling de uretra média versus cirurgia de Burch, quanto às curas objetiva (razão de chances [RC]: 1,29; intervalo de confiança de 95% [IC95%]: 0,76-2,20) e subjetiva (RC: 1,16; IC95%: 0,67- 2,00); sling de uretramédia transobturatório outside-in versus inside-out quanto às curas objetiva (RC: 0,78; IC95%: 0,45-1,35) e subjetiva (RC: 0,83; IC95%: 0,58-1,18); sling pubovaginal e de uretra média quanto à cura objetiva (RC: 1,64; IC 95%: 0,52-5,15). Comparando sling retropúbico comtransobturatório, o retropúbico foi superior quanto às curas objetiva (RC: 1,27; IC95%: 1,05-1,54) e subjetiva (RC: 1,23; IC95%: 1,02-1,48). Entre minislings e outros slings, houve diferença favorável a outros slings quanto à cura subjetiva (RC: 0,58; IC95%: 0,39-0,86) mas não quanto à cura objetiva (RC: 0,72; IC95%: 0,47-1,10). No grupo sling pubovaginal e Burch, houve diferença quanto à cura objetiva (RC: 2,04; IC95%: 1,50-2,77) e subjetiva (RC: 1,64; IC95%: 1,10-2,44). Slings de uretra média apresentam mais erosão, enquanto a cirurgia de Burch tem mais complicações na ferida operatória e infecção do trato urinário. Slings retropúbicos e pubovaginais sãomais retencionistas. Slings retropúbicos estãomais associados a lesão vascular, hematomas e perfuração vesical, e transobturatórios, à dor na perna e virilha, lesão neurológica e perfuração vaginal. Conclusão Slings pubovaginais são superiores à cirurgia de Burch, porém mais retencionistas. Slings retropúbicos são superiores aos transobturatórios, embora tenham mais eventos adversos. Outros slings são superiores aos minislings em relação ao aspecto subjetivo. Não houve diferença nas comparações entre slings de uretra média e cirurgia de Burch, slings pubovaginais, transobturatórios inside-out e inside-in.

Prospective and randomized clinical trial comparing transobturator versus retropubic sling in terms of efficacy and safety.

INTRODUCTION AND HYPOTHESIS: The midurethral sling is the most commonly performed surgical procedure for stress urinary incontinence (SUI). We compared the efficacy of transobturator tape (TOT) and retropubic (RP) slings by evaluating objective and subjective cure rates at 12 months postsurgery and evaluate the impact on quality of life (QoL) and record intra- and postoperative complications. METHODS: This was a randomized, controlled, prospective, clinical trial with analysis of noninferiority. The hypothesis was that the TOT sling is not inferior to the RP sling. A total of 92 women with SUI were selected and randomized into two groups: TOT and RP slings. RESULTS: Eighty-one patients maintained follow-up 12 months postoperatively. In the per-protocol analysis, the objective cure rates were 100% for the RP sling and 93% for the TOT sling (p = 0.029). The subjective cure rates were 92% for the RP sling and 90% for the TOT sling (p = 0.02). Because none of the upper limits of the confidence interval (CI) were above the noninferiority margin, noninferiority of the TOT sling could be concluded. In contrast, the intention-to-treat analysis could not show that the TOT sling was not inferior to the RP sling, because the upper limit of the CI surpassed the noninferiority margin. Postoperative complications were similar for both groups, except for higher urinary retention rates in the RP group. Regarding QoL, there was a significant improvement. CONCLUSIONS: The cure rates of the per-protocol analysis showed the noninferiority of the TOT relative to the RP sling. The RP sling group exhibited higher urinary retention. Quality of life improved significantly in both groups.

Análisis comparativo entre la colocación medio-uretral de malla sintética (cinta vaginal sin tensión [TVT] y cinta a través del músculo obturador [TOT]); en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en mujeres en un período de tiempo de 3 años (2009-2012) / Comparative analysis between the mid-urethral synthetic tape (tension-free vaginal tape [TVT] and transobturator tape [TOT]); in the surgical treatment of stress incontinence in women in a three-year period (2009 ­ 2012)

Introducción: la incontinencia urinaria de esfuerzo es la pérdida involuntaria de orina debido al aumento de presión intra- abdominal. El abordaje vaginal por cinta mediouretral es actualmente el método quirúrgico de elección para el tratamiento de IUE con las técnicas: cinta vaginal sin tensión (TVT) y cinta a través del músculo obturador (TOT). Objetivo: determinar la eficacia y complicaciones observadas after the placement of synthetic midurethral sling for the surgical treatment of urinary incontinence in a period of 3 years at HCAM. posterior a la colocación mediouretral de malla sintética TVT y TOT en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en un período de 3 años en el HCAM. Materiales y métodos: se realizó un análisis retrospectivo en pacientes que fueron sometidas a cirugía con la colocación de malla mediouretral para IUE en el HCAM. 218 pacientes fueron estudiados, se registraron datos clínico-demográficos, perioperatorios, transoperatorios, y del seguimiento postoperatorio incluidas complicaciones y mejoría clínica de la IU para evaluar la eficacia y seguridad de los métodos. TVT en la apreciación subjetiva y objetiva de la mejoría clínica (87% vs 82% y 92% vs 90% respectivamente). La perforación vesical se presentó en el 14% en el grupo TVT vs 0.5% del grupo TOT. Complicaciones graves que llevaron a reoperación se presentaron mayoritariamente en el grupo TVT (4.8% vs 2.25% / p= 0.356). Conclusiones: comparativamente, ambas técnicas mostraron similar eficacia a través del tiempo de estudio. Sin embargo TOT tendría menos complicaciones, especialmente en referencia a la perforación vesical. Además, TVT requirió mayor tiempo operatorio, estancia hospitalaria.

Introduction: stress urinary incontinence is the involuntary loss of urine due to increased intra-abdominal pressure. The vaginal approach using midurethral slings is now the most common surgical method for the treatment of SUI with two main techniques: tension free vaginal sling [TVT] and transobturator midurethral sling [TOT]. Objective: to determine the efficacy and complications observed after the placement of synthetic midurethral sling for the surgical treatment of urinary incontinence in a period of 3 years at HCAM. Materials and methods: a retrospective analysis was performed in patients who underwent surgery with placement of midurethral sling for the surgical treatment of SUI at HCAM. 218 patients were studied; clinical-demographics, perioperative, intraoperative, and postoperative complications including monitoring data and clinical improvement of SUI were recorded to assess the efficacy and safety of methods. Results: the TOT group prevailed in effectiveness with no statistically significant difference with respect to the TVT group in assessing subjective and objective clinical improvement (87% vs 82 % and 92 % vs 90 % respectively). Bladder perforation occurred in 14% in the TVT group vs. 0.5 % of the TOT group. Severe complications leading to re operation were mainly presented in the TVT group (4.8 % vs 2.25 % / p=0.356). Conclusions: comparatively, both techniques showed similar efficacy over time of study. However TOT would have fewer complications, bladder perforation being the most important. In addition, TVT required longer operative time, hospital stay.