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Does mobility of the bladder neck affect the choice of the sling and the outcome? retrospective cohort study
IUGA Academy. Švabík K. Jun 30, 2018; 212967; 363 Topic: Stress Incontinence
Dr. Kamil Švabík
Dr. Kamil Švabík

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363

Does mobility of the bladder neck affect the choice of the sling and the outcome? retrospective cohort study

Svabik, K1; Hubka, P1; Masata, J2; Martan, A1

1: First Faculty of Medicine, Charles University, General University Hospital Prague; 2: First Faculty of Medicine, Charles University, General University Hospital Prag

Introduction: Assessment of urethral mobility is not only an important element of standard urogynecological examination; it is also a significant element in surgeons’ decisions regarding the treatment choice in patients with stress urinary incontinence. We have data that increased mobility is is also associated with a greater likelihood that treatment will be successful.

Objective: From previous studies we know, that success of the midurethral sling is dependent on how tight this sling is placed. In clinical praxis exist a habit to place in low mobile uretra preferably retrobupic sling, expecting them to be placed tighter than transobturator slings. We have provided analysis of patients operated for urodynamic stress incontinence with retropubic or transobturator slings (TVTo, TVT Abbrevo) and compared the preopertive mobility of the urethra between the groups. More further we have looked on the outcome of the surgery, compared the tightness of the sling using sling-pubis gap parameter. We have try to explore the hypothesis, that the higher mobility of the urethra allows us to place sling looser with still good outcome

Methods: This is a retrospective analysis of urethral mobility of women diagnosed with urodynamic stress incontinence (USI) and treated with tension-free vaginal slings during the period 01/2009 - 10/2016. For each patient, urethral mobility data stored in form of 4D US volumes was available at the time of preoperative and postoperative assessment after the sling insertion.

Results: 427 patients were treated during the period. 350 women have available both 4D US volumes for analysis. The mean age was 56.5 years (min 29 - max 87, SD 7.9), mean BMI 27.4 (min 18.3 - max 39.6, SD 7.9), mean parity 2.14. There was a significant difference in mobility of the bladder neck (BN) between the groups (p ≤ 0,001). Mean BN mobility (angle gama) of patients treated by retropubic approach (n=103) was 31.1? (SD 17.8), by TVT-o (n=129) 37.0? (SD 21.8) and TVT Abbrevo (n=128) 45.7? (SD 20.8). In postoperative assessment after the sling placement the sling-pubis gap was in retropubic group 11.5 mm (CI ± 95% 11.1-11.9), in TVT-o group 12.7 mm (CI ± 95% 12.2-13.1) and in TVT Abbrevo group 12.2 (CI ± 95% 11.8-12.7); p = 0.001. In comparison of efficacy the success rate in retropubic group was 92.1%, TVT-o group 87.0% and TVT Abbrevo 89.8%; p = 0.46. When we compared the sling-pubis gap and mobility of the urethra in successfully treated women, we have found significant (p=0.003) but weak correlation.

Conclusions:
This study shows, that we treat patients with lower BN mobility preferably by retropubic approach. And this strategy proves to be successful. Despite disfavoring this group with risk group for failure the results are good. We have shown the mechanism of this effect - tighter sling. Nevertheless, this study shows, that if we insert the sling a little looser in patient with higher mobility, there is a still a chance for good effect.

Disclosure:

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Boston Scientific).

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