Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study

Abstract

ObjectiveTo evaluate and compare the clinical (patient’s morbidity, quality of life [QoL]) and economic impact of autologous vs synthetic slings in female stress urinary incontinence (SUI), as over the last decade, the introduction of synthetic vaginal tapes for managing SUI has gained wide acceptance being quicker with low morbidity. Synthetic vaginal tapes have been progressively replacing the use of autologous rectus fascia. However, the high cost of these synthetic tapes is almost always an obstacle for most patients of limited socio-economic resources in the Egyptian community.Patients and methodsThis retrospective study included 126 women with SUI. Data for patients that matched the study inclusion criteria were collected from the Urology Department of Ain-Shams University Hospitals from March 2011 to May 2013. Patients were categorised into two groups: Group I included 62 patients who underwent an autologous sling procedure using rectus sheath; and Group II included 64 patients that had a synthetic sling, using transobturator tape (TOT). The following variables were compared: operative time, postoperative pain scores, duration of indwelling urethral catheter, hospital stay, cost including the price of the synthetic tape when used, return to normal activity, and QoL assessment (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) before and after discharge from hospital.ResultsPatients amongst the two groups were normally distributed with no statistically significant differences in patient’s demographic data and comorbidities. The mean hospital stay was longer and the return to normal activity was delayed in Group I compared to Group II. The highest mean postoperative pain score was recorded in Group I. The overall morbidity was 12.9% and 4.68% in groups I and II, respectively. The mean (SD) overall cost was 2571.65 (254.8) and 3502.34 (196.9) Egyptian pounds (local currency) in groups I and II, respectively, being insignificantly lower in Group I when compared to Group II (P > 0.05). There were statistically significant differences between groups I and II for operative time, hospital stay, and postoperative pain scores. However, the differences in hospital cost amongst Group I and Group II were in favour of Group I. Post-surgical outcome was categorised into either complete cure (dry) or improved or failed with no significant differences in success rate and QoL amongst the study groups. The mean (SD) change in the QoL score was 10.95 (4.19) and 12.32 (4.1) in groups I and II, respectively. The higher success rate (complete cure) was in Group II, at 93.75%. Also, a statistically significant improvement of >70% of mean ICIQ-UI-SF score was shown in all groups when compared to baseline on both the 1- and 6-month follow-up visits.ConclusionAutologous grafts should be considered as a repair option in females with SUI in countries were health insurance policies do not cover the cost of synthetic materials in many instances. The cost-effectiveness of synthetic TOT...

Hybrid tape versus synthetic tape in treatment of female stress urinary incontinence .A prospective clinical study

“…The present prospective study shows that hybrid tape (Group I) and TOT groups (Group II) showed similar rates of immediate success in treating the SUI. The success rate of 90% for hybrid tape in Group I patients, in our present study is comparable to the Mourad et al [13] study.…”

Outcome of Syed’s Modified Pubo-Vaginal Fascial Rectus Sling Surgery in The Treatment of Female Urinary Incontinence - A Single Centre Experience

“…The success rate of about 100% at 3 years and 89.11% at 7 years for pubovaginal rectus sheath sling in our present study, is comparable to the Cross et al, and Sherif et al, studies [12,13]. A critical element is tying the suspension sutures to ensure continence without obstruction.…”

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer

“…PVS were performed in increasing numbers following the concerns about the use of mesh for prolapse surgery 27 and have comparable clinical outcomes to synthetic slings, without mesh-specific complications (Table 5). 28 Systematic reviews quote success rates between 46.9 and 90%. 22,29…”