Clinical and urodynamic evaluation of the polypropylene (marlex) sling for genuine stress incontinence

Hilton, Paul; Stanton, Stuart L.

doi:10.1002/nau.1930020208

Cited by 31 publications

(7 citation statements)

References 6 publications

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“…Several studies have found that patients undergoing unsuccessful surgery by anterior colporrhaphy (Weil et al 1984), colposuspension (Hilton & Stanton 1983a), sub‐urethral sling (Hilton & Stanton 1983c). and Marshall‐Marchetti‐Krantz (Behr et al 1986) and Stamey procedures (Hilton 1989) have lower pre‐operative MUCP and FUL than those treated successfully.…”

Section: Discussionmentioning

confidence: 99%

The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow‐up over four years

Hilton

Mayne

1991

BJOG

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Objective— To assess a modified Stamey endoscopic bladder neck suspension as a management for genuine stress incontinence in women unsuitable for colposuspension because of vaginal narrowing or inefficient voiding. Design— Uncontrolled observational study. Setting— Regional university gynaecological urology unit. Subjects— A hundred women, median age 58 years, with genuine stress incontinence confirmed by urodynamic investigation; 65 had had previous surgery for the same problem. Treatment— A Stamey procedure with monofilament nylon and short buffers of silastic tubing at each anchor site. Main outcome measures— Urodynamic reassessment 3 months after surgery and clinical follow‐up for up to 4 years, using life table methods. The median follow‐up was 27 months. Results— At 3 months the objective cure rate was 83%. Subjectively the cure rates at 4 years were 53% in patients under 65 years of age and 76% in those who were older. Overall mean bladder capacity decreased from 506 to 458 ml after surgery (P<0.05) and, in those who were cured, mean peak flow rate fell from 25.5 to 19.6 ml/s (P<0.05). The urethral functional length and the pressure transmission in the proximal three quarters were increased by successful surgery (P<0.01) but the resting urethral profile, voiding pressure and the frequency of detrusor instability were unchanged. Conclusions— This modification of the Stamey operation has an important role in the management of elderly patients those with previous unsuccessful operations, and those with inefficient voiding pre‐operatively.

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Section: Discussionmentioning

confidence: 99%

The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow‐up over four years

Hilton

Mayne

1991

BJOG

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“…Although the TVT procedure is similar in many ways to other pubovaginal procedures [16,17] the procedure is significantly different in that the sling mesh is placed at the midurethra rather than at the urethrovesical junction, and in that the TVT requires less dissection around the urethra it is therefore less likely to disrupt the blood and nerve supply to the urethra.…”

Section: Discussionmentioning

confidence: 99%

Tension‐free vaginal tape (TVT) procedure

2005

Intl J Gynecology & Obste

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Objective: To provide an introduction to the tension-free vaginal tape (TVT) procedure, placing it in the context of minimally invasive surgeries for the treatment of urinary stress incontinence in women, and to provide guidance to surgeons counseling women on the merits of this surgical choice. Options: This discussion is limited to surgical treatment of urinary stress incontinence in women. Evidence: A search of both MEDLINE and the Cochrane Library identified the most relevant medical evidence. This document represents an abstraction of the evidence rather than a methodological review. Values: This update is the consensus of the SubCommittee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada (SOGC). Benefits, harms, and costs: Counseling for the surgical treatment of urinary incontinence should consider the harms-benefits ratios of various options and include a measure of the bweightQ of the evidence. Recommendations: 1. The Burch procedure should be offered as the gold standard. The TVT procedure is promising but currently under evaluation in trials that will establish its efficacy and safety (II-3A). 2. Proper training is recommended prior to performing TVT procedures. 3. Long-term trial results are needed before the TVT procedure can be offered to patients as an equal alternative to the Burch procedure. Validation: This technical update has been approved by the Sub-Committee on Urogynaecology and Executive and Council of the SOGC.

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“…Knitted polypropylene is the material of choice in the majority of marketed products and is the result of multiple studies, which clearly demonstrated its superior biocompatibility profile [28][29][30]. Other materials originally considered by Ulmsten and Petros [1] for the sub-urethral sling included Mersilene [31][32][33], non-knitted polypropylene (Marlex) [34][35][36][37], expanding polytetrafluoroethylene (Goretex®) [38][39][40][41] as well as Dacron®-reinforced silastic [42]. These particular materials demonstrated inferior performance profiles compared to the current gold standard of knitted polypropylene mesh, as evidenced by higher rates of abscess formation and urethral and/or vaginal erosion.…”

Section: Biocompatibilitymentioning

confidence: 99%

The use of synthetic sub-urethral slings in the treatment of female stress urinary incontinence

Feifer

Corcos

2007

Int Urogynecol J

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We set out to review the existing literature regarding the use of synthetic suburethral sling products for the treatment of female stress urinary incontinence. Products currently implanted are examined and scrutinized, and evidence regarding their efficacy and complication rates is noted. Additionally, specifics of presently utilized synthetic materials, including construction method and biocompatibility, are explored and directly correlated to currently marketed products. This investigation was undertaken with the use of the Medline database. Studies pertaining to synthetic or surgical mesh, as well as each specific suburethral sling product, are included. Our findings and ultimately our recommendations stem from the preponderance of evidence supporting the continued use of knitted, macroporous polypropelene mesh slings. Several existing marketed products detailed in the study fit this description. Specific reference is made to recent reports of vaginal erosions and deep space infections related to several specific products. A cautionary note is also made regarding the implantation of transobturator sling products currently marketed without the necessary pre-market testing, potentially placing the public at risk. From the currently available literature on biomaterials, it seems clear that knitted macroporous polypropylene is the material of choice for suburethral implantation. With respect to the means and techniques by which these mesh materials are suburethrally implanted, the surgeon's choice often dictates which method is used, but recent experience has demonstrated that the transobturator approach can be equally as effective as the traditional tension-free vaginal tape, with less-associated morbidity. Ongoing randomized controlled trials will further clarify and distinguish between methods.

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Clinical and urodynamic evaluation of the polypropylene (marlex) sling for genuine stress incontinence

Cited by 31 publications

References 6 publications

The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow‐up over four years

The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow‐up over four years

Tension‐free vaginal tape (TVT) procedure

The use of synthetic sub-urethral slings in the treatment of female stress urinary incontinence

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