Sexual function and quality of life following retropubic TVT and single-incision sling in women with stress urinary incontinence: results of a prospective study

Abstract

PurposeThe objective of this prospective cohort study was to compare effectiveness, morbidity, quality of life (QoL) and sexual function in women treated with tension-free vaginal tape (TVT) versus single-incision sling (SIS) in the treatment of female stress urinary incontinence (SUI).MethodsRetropubic TVT sling or SIS was implanted in local anesthesia and patients were followed post-operatively for 6 months. Evaluation was performed to assess post-operative rate of continence, complications, changes in sexual function and patient reported quality of life. Female sexual function was evaluated before and after sling procedure using Female Sexual Function Index (FSFI) in sexually active patients.ResultsFrom January 2009 to December 2011, 150 patients were enrolled and underwent a procedure to implant the retropubic TVT (n = 75) or the MiniArc® and Ajust® SIS (n = 75). Overall, 93.3 % of the patients who successfully received SIS demonstrated total restoration (84 %) or improvement of continence (9.3 %) at the 6 month post-operative study visit. In TVT group we found 88 % total continence and 6.7 % improvement, respectively. Improvements were seen in the QoL scores related to global bladder feeling (89.3 %) in SIS group and 96 % for TVT. Post-operative FSFI score improves significantly and were comparable in both groups (SIS pre-operative 24.30 ± 4.56 to 27.22 ± 4.66 (P < 0.001) post-operative; TVT 24.63 ± 6.62 to 28.47 ± 4.41, respectively).ConclusionsThe SIS procedure appears to be as effective in improving incontinence-related quality of life and sexual function as the TVT through 6 months of post-operative follow-up. No differences in complications and sexual function were demonstrated between the groups.

A prospective observational cohort study of the Ajust® single incision sling performed under conscious sedation with local infiltration

“…This study shows that the Ajust® technique is as effective in the treatment of female SUI when administered under sedation with local infiltration, compared with general or spinal anesthesia. This result is comparable to other studies that have performed single incision mini‐slings under local anesthesia …”

“…With the intention to reduce the invasiveness of the transobturator procedure, third generation tapes (single incision slings) were developed. These minislings consist of a shorter polypropylene mesh, that during insertion only penetrates the obturator internal muscle and obturator membrane …”

“…Since insertion of the Ajust ® minisling is associated with a shorter operating time and is also experienced by patients as a less painful procedure, this allows for a surgical procedure under conscious sedation. In several European countries, the Ajust ® is already administered under local anesthesia . Perioperative, a cough test with full bladder can be performed, with a possibility to adjust the tape to the urethra, which might increase the objective cure rate of stress incontinence up to 89%‐95%, instead of the 77% described earlier .…”

“…These minislings consist of a shorter polypropylene mesh, that during insertion only penetrates the obturator internal muscle and obturator membrane. [3][4][5][6][7][8][9][10][11] Recently a randomized controlled trial (RCT) comparing TVT-O with Ajust ® was performed in our clinics, which showed that the Ajust® minisling is as effective as TVT-O in curing stress urinary incontinence. 12 Since insertion of the Ajust ® minisling is associated with a shorter operating time and is also experienced by patients as a less painful procedure, 12 this allows for a surgical procedure under conscious sedation.…”

Single-Incision Mini-Slings: Obturator Complex Pull-Out-Force Measurements

“…Yet, it is accompanied with several intra-and perioperative risks due to its high invasiveness and open abdominal approach possibly leading to prolonged hospitalization with extensive wound healing. The call for more innovative and less invasive treatment methods therefore rose in the past decades [5,6] . In 1995, Ulmsten and Petros [7] introduced a tension-free vaginal tape (TVT) as a far less invasive procedure in SUI-treatment becoming the most frequently applied surgical technique in urogynecology up to now [8][9][10] .…”