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PubMed2005

In vivo comparison of suburethral sling materials.

In vivo tissue responses were compared for three commercially available polypropylene suburethral slings that differ markedly in fabric structure and in size of resulting interstices and pores. All three elicited the same basic inflammatory response; however, individual fabric structures produced distinct differences in tissue formation within each mesh. The presence of numerous, closely spaced, small diameter filaments prevented formation of extensive fibrous connective tissue within two slings (ObTape and IVS Tunneller mesh). The much larger diameter monofilament and open knit structure of the Monarc sling permitted the most extensive fibrous tissue integration. These differences may be of interest to physicians considering clinical use.

Animals↗

PubMed2006

Functional results after the suburethral sling procedure for urinary stress incontinence: a prospective randomized multicentre study comparing the retropubic and transobturator routes.

OBJECTIVES: To compare short-term functional outcomes, urodynamic parameters, and quality of life of transobturator and retropubic routes in the cure of urinary stress incontinence. POPULATION AND METHODS: This prospective, multicentre study involved 88 women undergoing suburethral sling procedure for stress urinary incontinence (SUI). The retropubic route (RPR) and the transobturator route (TOR) were used in 42 and 46 women, respectively. No difference in epidemiologic and preoperative urinary functional status (SUI stage, and pollakiuria, nocturia, and urgency rates) was found between the groups. Functional results and quality of life were evaluated before surgery and at 1, 3, 6, and 12 mo postoperatively. Urodynamic examinations were performed before and 3 mo after surgery. RESULTS: The mean follow-up was 10 mo. No difference in the rate of de novo urge incontinence and immediate and late voiding dysfunction was noted between the groups. No difference in the cure rate was observed between the groups (89.3% in the RPR group and 88.6% in the TOR group). RPR was associated with a significant decrease in maximum urinary flow and an increase in residual urine volume. Quality of life was significantly improved after surgery without difference between the groups. CONCLUSIONS: Retropubic and transobturator routes for treatment of female SUI have similar high cure rates and quality of life improvement. Because of advantages in the rate of complications and postoperative pain previously demonstrated on the same population, the transobturator route appears to be the best option for the treatment of urinary incontinence.

Female↗

PubMed1992

Modified suburethral sling procedure for treatment of recurrent or severe stress urinary incontinence.

The most suitable material used to perform suburethral sling procedures for recurrent or severe stress urinary incontinence remains controversial. A comparison was made between two commonly used materials, synthetic Gore-Tex (expanded reinforced polytetrafluoroethylene) and autologous fascia lata. Both groups showed improved urethral pressure profiles postoperatively, but there was no difference in the magnitude of change between groups. The objective cure rate at six months for the Gore-Tex group was 100.0 versus 87.5 percent for the fascia lata group (p = 0.155). While there was no statistical difference between the incidence of de novo detrusor instability or length of postoperative bladder drainage (p = 0.104 and p = 0.978, respectively), there was a trend toward more postoperative complications of urinary obstruction in the Gore-Tex group.

Fascia Lata↗

PubMed1988

A suburethral sling procedure with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low urethral closure pressure.

One indication for suburethral sling procedures has been recurrent genuine stress incontinence after previous incontinence surgery. Patients with low urethral closure pressures (20 cm H2O or less) in association with genuine stress incontinence are at particular risk for failure of standard anti-incontinence procedures. Urodynamic evaluation was used to select 17 patients with genuine stress incontinence and low urethral closure pressures for surgical treatment with a sling procedure using polytetrafluoroethylene. The technique of the procedure, cure rate, and postoperative complications were assessed. An 85% subjective and objective cure rate was found on urodynamic testing three months postoperatively. Complications included wound seroma, urinary tract infection, and urinary retention.

Adult↗

PubMed2005

Groin pain after a tension-free vaginal tape or similar suburethral sling: management strategies.

OBJECTIVE: To review different treatment strategies for women with groin pain after tension-free vaginal tape (TVT) or similar suburethral sling procedures. PATIENTS AND METHODS: The series comprised 450 women who had a TVT procedure, with a follow-up of 3-50 months. Five women (1%) reported significant groin pain and were offered further treatment. In addition, one woman was referred from another centre and received treatment. RESULTS: Women with pain were initially treated conservatively, and in most the pain resolved and required no further treatment. Persistent or severe discomfort was treated with a combined steroid (methyl prednisolone, 2 mL, 80 mg) and local anaesthetic (bupivacaine, 10 mL, 0.5%) injection in four women. There were no side-effects from the treatment. One woman was relieved of her pain and required no further treatment. In one woman the local injections failed to improve her symptoms but the pain was not severe enough to warrant further treatment. Two women developed recurrent pain after an initially successful injection, and in these women the TVT was excised. One woman referred from another centre was primarily treated with TVT excision. In the three women treated with distal tape excision, the mean pain scores decreased from 8.7 before excision to 0.7 afterward. One woman is awaiting tape excision. CONCLUSION: If conservative management fails to relieve the symptoms of groin pain it can be treated by injecting a mixture of steroid and local anaesthetic. However, local injection failed to provide long-term relief in three of four women. More severe symptoms might require TVT mesh dissection and excision, which provided significant pain relief.

Anesthetics, Local↗

PubMed1989

A clinical and urodynamic study comparing the Stamey bladder neck suspension and suburethral sling procedures in the treatment of genuine stress incontinence.

Twenty women with urodynamically proven genuine stress incontinence were randomly allocated to treatment by suburethral sling or Stamey endoscopic bladder neck suspension. Urodynamic assessment was performed before and 3 months after surgery; clinical follow-up is reported up to 2 years. Blood loss was greater, and there were significantly more postoperative complications associated with the sling procedures. The subjective and objective cure rates at 3 months and 2 years were not significantly different between the two procedures. No significant changes in the resting urethral pressure profile were evident, although with both procedures, cure was associated with an enhancement in pressure transmission ratios in the proximal urethra. Detrusor instability occurring for the first time after operation was associated with both procedures; the sling, in addition, induced a significant degree of outflow obstruction, although this was not evident after the Stamey procedure.

Adult↗

PubMed2003

[Synthetic suburethral sling in the treatment of stress urinary incontinence in women].

Since the marketing and success of the TVT technique, other products have been released onto the suburethral sling market. These products can be classified according to four main criteria: TAPE: The material used in every case is polypropylene, in the form of woven monofilaments (TVT, Sparc, Monarc, Uretex Sup), multi-filaments (IVS, Safyre comprising two silicone tension bands), extruded crosslinked polypropylene (Obtape) or silicone-coated polypropylene in contact with the urethra (Uratape). A larger space between the fibres is associated with a lower theoretical risk of infection and better tissue ingrowth. The weaving process of Uretex Sap tape decreases the warping and release effect. Extruded polypropylene forms a very solid, but poorly elastic tape. It is not yet clear whether silicone-coating is an advantage or a disadvantage. INCISION: The ascending retropubic approach (TVT, Uretex Sup, IVS) is now well known. It carries a risk of bladder perforation and, more exceptionally, intestinal or vascular injuries. The descending retropubic approach (Uretex Sup, Sparc) requires more extensive vaginal dissection and carries a risk of bladder perforation. The mixed retropubic approach (Uretex Sup) combines the potential disadvantages of the ascending and descending approaches. The transobturator approach (Uratape, Obtape, Monarc) was described more recently and is easy to learn. It does not carry any risk of intestinal or vascular injury, but the urethra, vagina or even the bladder (in the case of lateral cystocele) can be damaged by this incision. INSTRUMENTS: Ease of use is an essential feature. Uretex Sup comprises ancillary instruments and a technique requiring multiple manipulations. Sparc tape cannot be easily dissociated from the ancillary instruments when a second passage is necessary. TVT and Uratape use resterilizable instruments, while the other products are totally disposable. FOLLOW-UP AND PUBLICATIONS: Only TVT has a sufficient follow-up and several hundred specific papers or publications. Only a few publications by a few different teams are currently available for the other products. In conclusion, the various published studies confirm the qualities and good tolerance of woven monofilament polypropylene. The other materials require a longer follow-up and more studies before they can be completely validated in terms of results and morbidity. The multiple surgical approaches and the various ancillary instruments available allow the technique to be adapted to each patient and each surgeon, regardless of his or her initial training and habits.

Biocompatible Materials↗

PubMed2005

Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings.

OBJECTIVE: The purpose of this study was to examine the histopathologic changes of HMDI (Hexamethylene di-isocyanate) cross-linked porcine dermis grafts used for suburethral sling surgery. STUDY DESIGN: Twelve patients underwent reoperation with graft removal for urinary retention or recurrent stress urinary incontinence after transvaginal sling surgery. Tissue specimens were available for pathologic evaluation in 7 patients. Graft specimens underwent histologic preparation including hematoxylin and eosin staining. A single pathologist reviewed the slides blinded to clinical outcomes. RESULTS: Histopathologic analyses revealed only limited collagen remodeling, and evidence of a foreign body type reaction was present in some specimens. In cases of recurrent stress incontinence, implants appeared to be completely replaced by dense fibroconnective tissue and moderate neovascularization without evidence of inflammation or graft remnants. CONCLUSION: HMDI cross-linked porcine dermal collagen implants result in variable tissue reactions that may have unpredictable clinical outcomes in different patients, raising questions about the overall tolerability and efficacy of these grafts in pelvic reconstructive surgery.

Animals↗

PubMed1990

[Suburethral sling procedure for urinary stress incontinence. With special reference to determination of tension of suspension from posturethrovesical angle measured by ultrasonography].

Ten patients with urinary stress incontinence were treated by suburethral sling procedure using a polytetrafluoroethylene tube as the sling. The tension of suspension was determined by the post-urethrovesical angle measured by transrectal ultrasonography in each patient. In nine patients, the post-urethrovesical angle ranged from 90 to 110 degrees, and urinary continence of the patients was completely obtained. The remaining one patient whose post-urethrovesical angle was determined as 120 degrees could not obtain complete continence. None of the patients had subjective post-operative disturbance in urination and the peak flow rate of post-operative uroflowmetry hardly decreased in 7 patients in whom this was performed. Although post-urethrovesical angles reduced as the tension which suspended the bladder neck increased, the tension reforming the post-urethrovesical angle was various in each patient. Since one of the aims of suspension of the bladder neck for patients with stress incontinence is reform of the post-urethrovesical angles, correct and reasonable tension of suspension is to be obtained by measuring the post-urethrovesical angle.

Adult↗

PubMed1998

Clinical and urodynamic predictors of delayed voiding after fascia lata suburethral sling.

OBJECTIVE: To determine the time to resumption of normal voiding after a fascia lata sling and whether any clinical, operative, or urodynamic variables predict it. METHODS: Between January 1993 and September 1996, 62 women underwent fascia lata suburethral sling operations for intrinsic sphincter deficiency or recurrent stress incontinence. The demographic, operative, and urodynamic data of 61 of these patients were analyzed. RESULTS: The mean number of days to resumption of normal voiding was ten. Three patients (5%) developed permanent retention. Patients 65 years and older were more likely than younger patients to have prolonged catheterization (16 versus 7 days, P=.008). Women who had additional procedures voided at a mean of 15 days compared to nine days for those having slings only (P=.029). A preoperative urine flow rate less than 20 mL/sec was associated with late voiding. There was no significant relationship between preoperative voiding mechanism and voiding time. CONCLUSION: Resumption of normal voiding occurred earlier than reported by others. Age over 65 years, additional surgical procedures, and low peak flow rates were risk factors for delayed voiding. Time to normal voiding was independent of the preoperative voiding mechanism.

Adult↗

PubMed2005

Suburethral sling treatment of occult stress incontinence and intrinsic sphincter deficiency in women with severe vaginal prolapse of the anterior vs posterior/apical compartment.

OBJECTIVE: The purpose of this study was to compare the efficacy of a Mersilene mesh suburethral sling for occult stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) in women with severe vaginal prolapse of the anterior compartment to the posterior/apical compartment. STUDY DESIGN: This was a retrospective study that compared women with stage or grade III/IV prolapse of the anterior compartment (group 1) with the posterior/apical compartment (group 2); both groups demonstrated occult SUI (leakage only with prolapse reduced) and ISD on urodynamics, and underwent concurrent pelvic reconstructive surgery. The sling was defined as efficacious if SUI was prevented in 85% of women and if obstructive symptoms (de novo or worsening urge incontinence, or urinary retention greater than 2 weeks) occurred in less than 10% of women. RESULTS: There were 39 women in group 1 and 25 women in group 2. There were no differences between women in group 1 or group 2 in preoperative demographics (except parity) or urodynamic findings. SUI cure rates were lower for group 1 than group 2, but this difference was not significant (87% vs 100%, P = .15). Rates of de novo or worsening urge incontinence (8% vs 4%, P = 1.00) and urinary retention (none occurred) were similar between groups. CONCLUSION: In women with severe vaginal prolapse, slings effectively treat occult SUI and ISD, whether associated with anterior or posterior/apical prolapse.

Aged↗

PubMed2000

Ball urethroplasty combined with Marshall-Marchetti-Krantz urethropexy versus suburethral sling in patients with intrinsic sphincter deficiency and urethral hypermobility.

OBJECTIVE: It was our goal to compare the efficacy of a suburethral fascial sling with that of a combination of Marshall-Marchetti-Krantz urethropexy and Ball urethroplasty in patients with intrinsic sphincter deficiency and urethral hypermobility. STUDY DESIGN: This study consisted of a retrospective observational evaluation of patients from 2 separate practice sites. Preoperative and postoperative data were collected from patients' medical records. The long-term results were based on a mailed questionnaire addressing bladder symptoms and quality-of-life issues. RESULTS: Among a total of 48 patients, 37 (77. 1%) responded in the group undergoing Marshall-Marchetti-Krantz urethropexy combined with Ball urethroplasty, and 30 out of 35 (85.7%) patients replied in the suburethral fascial sling group. The mean length of follow-up was 2. 7 years (range, 1-5 years). The patients were similar in age, hormonal status, parity, and previous bladder neck surgery. Similar cure and improvement were demonstrated in both groups (86.6% in the suburethral fascia group and 89.2% in the group with the Marshall-Marchetti-Krantz procedure combined with Ball urethroplasty). No significant differences were found in urinary incontinence types, irritable bladder symptoms, voiding difficulties, or quality-of-life measures. CONCLUSIONS: The suburethral fascial sling and a procedure consisting of Marshall-Marchetti-Krantz urethropexy combined with Ball urethroplasty have similar results in patients with intrinsic sphincter and urethral hypermobility.

Adult↗

PubMed2006

[Pregnancy after transobturator insertion of a suburethral sling: a case report and review of the literature].

Rare cases of pregnancy occur after surgical treatment of an urinary incontinence. We report the case of a 37-year-old patient became pregnant 5 months after trans-obturator insertion of a suburethral sling (Monarc). The pregnancy was monitored regularly and no sign of urinary incontinence was observed. Caesarean delivery was decided at 40 weeks gestation. The patient has remained quite continent, one year after delivery. The appropriate mode of delivery is discussed.

Adult↗

PubMed2003

Analysis of retropubic colpourethrosuspension results by suburethral sling with REMEEX prosthesis.

OBJECTIVE: To describe the results after colpourethropexy with a REMEEX prosthesis in the treatment of stress urinary incontinence with associated genital prolapse. MATERIALS AND METHODS: A prospective analysis of all patients treated in our Urogynaecology Unit between November 2000 and March 2001. RESULTS: There were 29 patients with mean age of 62 and mean body mass index of 28. All but one patients had stress incontinence (genuine or mixed) associated with a genital prolapse. The other patient was a failed past technique (Marshall-Burch). Cystometry was performed in 80% of the patients. Of these 93% had genuine stress incontinence and 7% mixed incontinence. The average operating time was 119min (CI: 60-310), and the mean hospital stay 5 days (CI: 3-13). There was one case of severe haemorrhage during surgery, four cases of wall seroma and one postoperative urinary infection. Concerning patient satisfaction, 90% of our patients felt they were cured, 8% were much better and 2% had a slight improvement. No patient had a worsening of symptoms after surgery. CONCLUSION: We propose colpourethropexy by suburethral sling with a REMEEX prosthesis as suitable treatment for stress incontinence with associated genital prolapse.

Female↗

PubMed2004

Sexual function in women before and after suburethral sling operation for stress urinary incontinence: a retrospective questionnaire study.

BACKGROUND: The aim of this questionnaire study dealing with women with stress urinary incontinence was to find out what influence incontinence and operation for incontinence in the form of tension-free vaginal tape (TVT) or intravaginal slingplasty operation (IVS) had on the patient's sexuality and if there were any adverse effects on sexuality after the operation. METHODS: Eighty-four patients were operated on from April 1998 to September 2002. A questionnaire was sent to all patients with questions concerning their sexuality before and after the operation. RESULTS: Sixty-seven patients (81%) answered the questionnaire. Before the operation 53 patients (79%) were sexually active and 26 patients (49%) experienced incontinence during intercourse. Only one patient (0.01%) stated the incontinence as the reason for not being sexually active. No patients developed de novo incontinence during intercourse after the operation. Half of the patients who were cured of their incontinence during intercourse experienced a better sexual life. Five patients (7%) cited reduced libido after the operation and two patients (3%) felt the operation to be the cause. CONCLUSION: Among sexually active women with stress urinary incontinence referred for suburethral sling operation 49% experienced incontinence during intercourse and half of the cured patients in this group experienced a better sexual life after the operation. Incontinence affects sexual life to a great extend. Two patients (4%) experienced less libido after the operation and found the operation to be the cause of this. The risk of deterioration of sexual life after the operation is very small. Further investigation into this subject is needed.

Adult↗

PubMed2005

Peri-operative complications and pain after the suburethral sling procedure for urinary stress incontinence: a French prospective randomised multicentre study comparing the retropubic and transobturator routes.

OBJECTIVE: To compare peri-operative complications, pain, and the immediate functional results of the sub-urethral sling procedure for urinary stress incontinence by the retropublic and transobturator routes, using a non-elastic polypropylene sub-urethral sling. PATIENTS AND METHODS: This prospective, multicentre study involved 88 women undergoing the sub-urethral sling procedure for stress urinary incontinence (SUI). The retropubic route (RPR) and the transobturator route (TOR) were used in respectively 42 and 46 cases. The characteristics of the women in the RPR and TOR groups were as follows: mean age (+/-standard deviation) 56.8+/-12 years and 53.4+/-10 years, respectively; mean BMI: 25+/-4 and 26+/-4; mean parity: 2.1+/-0.9 and 2+/-1 children; post-menopausal status: 66.7% and 58.7%; prior surgery for SUI: 7.1% and 6.5%; and prior hysterectomy: 21.4% and 26.1%. None of these characteristics differed significantly between the groups. Likewise, pre-operative urinary functional status (SUI stage, and pollakiuria, nocturia and urgency rates) was similar in the two groups. RESULTS: Mean hospital stay and overall morbidity rate were not significantly different between the RPR and TOR groups. Mean operating time was longer in the RPR group. Bladder injury was significantly more frequent in the RPR group and vaginal injury was significantly more frequent in the TOR group. Pain scores were significantly lower in the TOR group. The objective functional results at one month did not differ between the groups. Quality of life, evaluated with questionnaires and numerical rating scales, was similarly improved in the two groups. DISCUSSION: The suburethral sling procedure was less painful by the TOR route than by the RPR route. Bladder injury, haematomas and abscesses were only observed in the RPR group, while vaginal injury only occurred in the TOR group. The immediate functional results of the two approaches were similar.

Adult↗

PubMed2003

Sinus formation after insertion of a silicone-coated suburethral sling.

We report the case of a 65-year-old woman who developed a sinus tract after a suburethral synthetic silicone mesh sling placement. After removal of the sling material with debridement and reconstruction of the suburethral tissue, fascia lata harvest with a sling to abdominal rectus fascia was performed. Silicone mesh may erode to form a sinus tract if used as suburethral sling material.

Aged↗

PubMed2004

Complications of synthetic graft materials used in suburethral sling procedures.

Problems relating to the erosion of sling material, through either the vagina or the urethra, have been encountered with almost all kinds of synthetic sling materials. We present four unusual cases of women using different synthetic materials and the complications that occurred. The biopsies were examined histologically and analyzed for collagen and inflammatory reactions. Four patients who underwent suburethral slingplasty previously with different sling materials required surgical management for complications, including one intravesical Ethibond migration, vaginal mucosal mesh erosion in two patients, and one proximal urethral overcorrection with intravesical erosion. We reviewed the literature regarding the amount of mesh erosion and connective tissue reaction with synthetic materials. The efficiency of mesh removal was assessed. The four patients maintained urinary continence after urethrolysis and removal of the mesh. Fibrosis and severe inflammatory reactions were found in the connective tissue adjacent to the mesh as well as the Prolene mesh. Technically, it would be easier to remove the graft of patch sling if rejection or erosion occurs.

Adult↗