Randomized comparison of the suprapubic arc sling procedure vs tension-free vaginal taping for stress incontinent women

Abstract

The purpose of this study was to compare the surgical outcome and attendant complications of the suprapubic arc (SPARC) sling and tension-free vaginal tape (TVT) procedures. Sixty-two women with genuine stress incontinence (GSI) alone or combined with pelvic prolapse less than International Continence Society (ICS) stage II were randomly allocated to either SPARC or TVT groups. A routine suprapubic ultrasonography was performed for all patients 1 day after the anti-incontinence operation. A comparison of the peri- and postoperative results comprising surgical outcomes and complications revealed no significant differences between the two groups. Although the difference in the rates of bladder injury was not statistically significant (SPARC 12.9 vs TVT 0.0%, p = 0.112), it was clinically significant. Routine suprapubic ultrasonography revealed eight subjects had retropubic hematomas greater than 5 cm. The cure rate for SPARC was not significantly different from TVT (80.7 vs 87.1%, p = 0.706). We concluded that the SPARC sling and TVT procedures proved to be equally effective. Subsequent suprapubic ultrasonography, in particular for the symptomatic patients, was found to be of clinical merit.

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

“…Upon review of the literature, there is very little di¡erence between midurethral slings and TOT's with regard to postoperative DO and UUI in the majority of studies [Boustead, 2002;Davila et al, 2005;de Tayrac et al, 2005;Tseng et al, 2005]. With regards to urgency outcomes, two studies wary widely.…”

“…Since the advent of the TVT by Ulmsten and Petros [1995], Delorme [2001] has described a new approach to midurethral slings using the trans obturator route. These new procedures may have similar e⁄cacy rates to the retropubic midurethral slings in addition to decreasing complication rates related to bladder perforations and vascular injuries described with the retropubic midurethral slings [Wang et al, 2005].…”

“…These symptoms pose a dilemma for both patients and surgeons treating stress urinary incontinence due to their adverse impact on the patients' quality of life and satisfaction from the surgery [Boustead, 2002]. Most studies reporting UUI range from 5 to 25% after midurethral slings or trans obturator tapes (TOT's) [Boustead, 2002;Davila et al, 2005;deTayrac et al, 2005;Tseng et al, 2005]. Few studies, however, directly compare or focus on the rates of persistent or de novo DO and UUI after various sling types.…”

Lynx® midurethral sling system: a 1-year prospective study on efficacy and safety

“…There has been some controversy as to the comparable success rates when comparing the top-down vs. the bottom-up approach. There have been four randomized, prospective studies comparing the TVT sling (bottom-up) to the suprapubic arch (SPARC) sling (top-down) [9][10][11][12]. Three of the four studies showed equivalence of the TVT to the SPARC sling systems [9,10,12] with the longest follow-up at 25 months showing continence rates of 87% vs. 81%, respectively.…”

“…There have been four randomized, prospective studies comparing the TVT sling (bottom-up) to the suprapubic arch (SPARC) sling (top-down) [9][10][11][12]. Three of the four studies showed equivalence of the TVT to the SPARC sling systems [9,10,12] with the longest follow-up at 25 months showing continence rates of 87% vs. 81%, respectively. [12] However, a study by Lord et al, which had the largest number of patients (147 TVT vs. 154 SPARC), showed superiority of the TVT over the SPARC with 87% vs. 77% success rates, respectively.…”