Adjustable midurethral sling as a routine procedure for uncomplicated stress urinary incontinence
IUGA Academy. Staroseltseva O. Jun 30, 2018; 213261
Topic: Stress Incontinence
Olga Staroseltseva
Olga Staroseltseva

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Adjustable midurethral sling as a routine procedure for uncomplicated stress urinary incontinence

Staroseltseva, O1;Shkarupa, D1; Kubin, N1; Shapovalova, E1; Zaytseva, A1

1: Saint-Petersburg State University Clinic of advanced medical technologies n.a. Nikolay I. Pirogov

Introduction:There is a widespread view that midurethral sling (MUS) is a perfect procedure with no need for improvement. But the evidence shows another picture. According to the latest Cochrane database, the average short-term transobturator tape objective effectiveness is 85.7% with great fluctuation of results from 50.0% to 98.0%. At the same time, it is well known that bladder outlet obstruction occurs in 2-25% patients after MUS (1). In 2017 the IUGA Research and Development committee published their opinion on treatment of postoperative voiding dysfunction (VD) following MUS. The early MUS mobilization was considered a recommended option (2). The advantages of adjustable MUS for SUI treatment are looking obvious, but there is still no enough experience for its wide use.

Objective: To evaluate the effectiveness and safety of adjustable MUS for treating SUI.

Methods: In this study we included patients with primary uncomplicated SUI who received the transobturator adjustable sling (Fig.1) between January 2015 and August 2017. The pre- and postoperative assessment included medical history, pelvic examination, cough stress test (CST) in supine and standing position, uroflowmetry, bladder ultrasound and post-void residual (PVR) urine measurement and questionnaires. The tape tension adjustment was performed during 2 days after surgery and included its tightening or loosening, depending on the CST, uroflowmetry and PVR results (Fig.2).

Results: A total of 832 women underwent the surgery. Mean surgery time was 14.2 ± 4.5 min. There were no intraoperative complications. The adjustment was performed in 258 (31.0%) patients (Tab.1). Only 4 (0,5%) patients demonstrated persistent SUI after repeated tension adjustment. In 5 (0.6%) patients PVR was >150 ml, despite loosening of the sling. Two of them had postoperative bladder atony, that was successfully treated by conservative methods, and 3 patients underwent sling revision due to persistent urinary retention. Mean follow-up was 14,6 months (SD 7.2, range 6-33). The objective cure rate was 94.7% (n=788). Postoperative complications included de novo overactive bladder (2.8%), vaginal mesh extrusion (0.7%) and pain syndrome within 6 weeks (0.2%). The questionnaires scores showed 96,3% (n=802) patients to be very satisfied (p<0,001).

Conclusion: Almost in every 3rd patient the outcomes of MUS procedure were deficient. In our clinic we have been using the adjustable MUS as a routine surgical method since 2015. The fine and reversible tuning of the tape in early postoperative period is a simple and minimally invasive intervention, that may improve the surgery effectiveness and significantly decrease the VD frequency. Adjustable transobturator tape proved to be reliable and safe method of SUI management and can be used as a standard procedure in patients with SUI.

1. Malacarne DR, Nitti VW. Post-Sling Urinary Retention in Women. Curr Urol Rep. 2016 Nov;17(11):83.

2. Bazi T, Kerkhof MH, Takahashi SI, Abdel-Fattah M; IUGA Research and Development Committee. Management of post-midurethral sling voiding dysfunction. International Urogynecological Association research and development committee opinion. Int Urogynecol J. 2018 Jan;29(1):23-28.


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