Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slings

Abstract

Aims: To compare the rates of resolution of detrusor overactivity (DO) and subjective urge urinary incontinence (UUI) as well as de novo DO and UUI between the Monarc, TVT, and SPARC midurethral sling procedures. Methods: Two hundred and seventy-six subjects with urodynamic stress or mixed urinary incontinence underwent retropubic midurethral slings (TVT, N ¼ 99; SPARC, N ¼ 52) or transobturator slings (Monarc, N ¼ 125). All evaluable subjects had a routine o⁄ce evaluation, subjective assessment of UUI, and multichannel urodynamic testing pre-and 3 months postoperatively. Comparisons were made using Student's t-test, ANOVA, McNemar's test, and Chi-Square test where appropriate. Multivariate logistic regression was performed to detect possible confounding factors such as sling type, and di¡erences in concomitant surgical procedures. Results: De novo subjective UUI di¡ered signi¢cantly between the Monarc and the other two slings (33% TVT vs. 8% Monarc vs. 17% SPARC, P ¼ 0.04). Fourteen to Sixteen percents of patients with preoperative UUI who underwent TVT or SPARC had worsening of their UUI symptoms while only 6% of the Monarc group did (P ¼ 0.02). There was no di¡erence in rates of resolution of DO among the three groups (40% vs. 48% vs. 32%, P ¼ 0.39) or de novo DO (32% vs. 22% vs. 22%, P ¼ 0.64) at 3 months. Conclusions: Patients who undergo transobturator procedures have signi¢-cantly lower rates of de novo UUI than those who undergo midurethral sling procedures. Rates of resolution of DO, UUI, and de novo DO do not di¡er between groups. Neurourol. Urodynam. 26:42^45, 2007. ß 2006

Outcomes of autologous fascial slingplasty procedure for treating female urinary incontinence

“…Botros et al reported that the incidence of de novo DO was found in 33% of TVT, 8% of Monarc, and 17% of SPARC. Meanwhile, they also found that patients in the midurethral sling group had significantly lower rates of de novo DO than patients in the bladder neck sling group (29% vs 62%, P<0.05) [21,22]. In comparison, we had a relatively lower de novo DO rate (24%) than that of Botros et al Cardozo et al suggested that de novo DO is a result of nerve damage after bladder dissection and not necessarily a result of obstruction [23].…”

A microbiological and immunohistochemical analysis of periurethral and vaginal tissue in women with de novo urge symptoms after mid-urethral sling procedures—a prospective case-controlled study

“…This issue has been rarely ever reported other than by Deval et al, Falconer et al, and Botros et al. They briefly hypothesized that the changes in paraurethral collagen metabolism or sclerosis around the sling, or the effect position of the sling may elicit the new onset of urge symptoms [2,3,5].…”

A retrospective comparative series comparing monarc and sparc suburethral slings

“…Kim [12] conducted a prospective randomised trial of SPARC (n = 22) and Monarc (n = 21) surgeries, and reported similar short term cures rates (81.8% vs 80.9%) Botros [13] retrospectively compared Monarc (n = 125), Sparc (n = 52), and TVT (n = 99) slings and reported at 3 months the Monarc group had significantly less detrusor overactivity symptoms (8% vs 17% Sparcvs 33% TVT). This finding is similar to this present study.…”