Which type of mid‐urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension‐free vaginal tape or transobturator tape

Güngördük, Kemal; Çelebi, İbrahim; Ark, Cemal; Celikkol, Ozgu; Yıldırım, Gökhan

doi:10.1080/00016340903100354

Cited by 37 publications

(13 citation statements)

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“…For women with ISD (maximum urethral closure pressure less than 20 cm H 2 O), the retropubic tape appears to be a better option because it is more obstructive [24, 26–28]. After a longer period of follow-up, women with SUI and ISD are significantly less likely to require further SUI surgery with the retropubic tape than the TOT [29].…”

Section: Discussionmentioning

confidence: 99%

The value of preoperative urodynamics according to gynecologists and urologists with special interest in stress urinary incontinence

et al. 2011

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Introduction and hypothesisThe aim of this study is to assess variations in practice in the use of preoperative urodynamics in women with stress urinary incontinence (SUI).MethodsWe performed an E-survey among all Dutch gynecologists and urologists who have SUI as focus in daily practice. The questions concerned the common policy and preferred policy. Descriptive statistics were used.ResultsOf the 260 targeted specialists, 163 (63%) responded. We found that 37% of the respondents performed standard preoperative urodynamics; in the preferred practice, this would reduce to only 18%. Eighty percent indicated they would operate a patient with a positive stress test without urodynamic SUI, whereas 21% would do this also in case the clinical stress test was negative. Only 9% of the respondents indicated they adapted the choice of the type of sling based on urethral pressure profilometry parameters.ConclusionsUrodynamics are not routinely performed, and outcomes hardly influence the choice of treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s00192-011-1565-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The value of preoperative urodynamics according to gynecologists and urologists with special interest in stress urinary incontinence

et al. 2011

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“…De facto, as mulheres com IUE com incompetência esfincteriana e uretra fixa têm uma IUE mais grave e uma menor taxa de sucesso cirúrgico do que as mulheres com IUE e uretra mó-vel. 13,14 A taxa de sucesso nas doentes com incompetência esfincteriana, é de apenas 70%, 13,30 semelhante à amostra em estudo descrita. Há autores que defendem que, para este tipo de IUE, a técnica retropúbica é a opção cirúrgica mais adequada.…”

Section: Discussionunclassified

“…Há autores que defendem que, para este tipo de IUE, a técnica retropúbica é a opção cirúrgica mais adequada. 13,30 A explicação assenta nos diferentes eixos dos slings. O eixo do sling retropúbico é perpendicular ao eixo uretral, contrariamente ao eixo agudo do sling transobturador.…”

Section: Discussionunclassified

“…Deste modo o sling retropúbico tem a forma de um segmento suspensivo em 'U' e um estreito ângulo sob a uretra em repouso, criando uma maior compressão circunferencial da uretra e um aumento da pressão uretral. 13,14 No nosso estudo verificou-se que a taxa de sucesso foi superior no grupo das doentes que realizaram outras cirurgias vaginais concomitantemente. No entanto, esta diferença não foi significativa (p = 0,753).…”

Section: Discussionunclassified

“…Nas doentes submetidas a estudo urodinâmico, a incompetência esfincteriana foi designada quando se observou perda de urina com a manobra de Valsalva, para pressões inferiores a 60cm H 2 O, ou quando a pressão máxima de encerramento da uretra foi inferior a 20 cm de H 2 O. [13][14][15] As técnicas cirúrgicas foram realizadas de acordo com o descrito na literatura. Nas situações em que concomitantemente à colocação de prótese suburetral foi realizada outra cirurgia vaginal, a prótese foi colocada em segundo lugar e numa incisão vaginal distinta.…”

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Técnicas Transobturadoras na Incontinência Urinária de Esforço Feminina

et al. 2014

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). Ambas as técnicas foram concebidas com o intuito de evitar a passagem no espaço retropúbico, reduzindo assim o número de complicações. Conclusão: As taxas de cura para as abordagens transobturadoras oscilam entre 80 e 95%. A taxa de cura aumenta quando o mecanismo responsável pela incontinência urinária de esforço é a hipermobilidade da uretra, contudo não é alterada quando são realizadas concomitantemente outras cirurgias vaginais. Palavras-chave: Incontinência Urinária de Esforço; Slings Suburetrais. ABSTRACTIntroduction: Stress urinary incontinence affects about 20-40% of women. Treatment with transobturator mid-urethral slings is consensually accepted nowadays. The goal of this study was to evaluate the success rate and most frequent complications of surgical treatment with transobturator mid-urethral slings in stress urinary incontinence. Material and Methods:This study evaluated 363 patients who underwent correction of stress urinary incontinence with a transobturator tape in Hospitais da Universidade de Coimbra between January 1st 2008 and July 1st 2010. Results:The mean age of patients was 56 . In 13.5% of women, the correction of stress urinary incontinence was associated with other vaginal surgery. The majority of these women (95.3%) had urethral hypermobility. Only 0.8% of women suffered of perioperative complications, 5.2% of immediate postoperative complications and 15.7% of late postoperative complications. The global success rate was 93.7%. The success rate in patients with fixed urethra was lower (77.8%) comparing with the results of those with urethral hypermobility, being successful in 94.5% (p = 0.02). The success rate was similar in patients with or without vaginal surgeries. Discussion: Treatment with transobturator mid-urethral slings has high success rates and it became the first treatment chosen to stress urinary incontinence, even if they were treated with the technique outside-in (TOT. Both techniques were conceived to avoid passing through the retropubic space, decreasing the complicate matters number. Conclusions: The cure rates for the transobturator surgical approach range between 80 and 95%. The cure rate increases when the mechanism responsible for the urinary incontinence is urethral hypermobility, although it is not modified when are performed other vaginal surgeries concomitantly.

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Comments on “A randomized trial of urodynamic testing before stress‐incontinence surgery” (N Engl J Med. 2012 May 24;366(21):1987–1997) From the Italian Society of Urodynamics

Finazzi‐Agrò

Serati

Salvatore

et al. 2012

Neurourology and Urodynamics

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Which type of mid‐urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension‐free vaginal tape or transobturator tape

Abstract: TVT appears to be the preferable surgical option for the treatment of SUI with intrinsic sphincter deficiency.

Cited by 37 publications

References 38 publications

The value of preoperative urodynamics according to gynecologists and urologists with special interest in stress urinary incontinence

The value of preoperative urodynamics according to gynecologists and urologists with special interest in stress urinary incontinence

Técnicas Transobturadoras na Incontinência Urinária de Esforço Feminina

Comments on “A randomized trial of urodynamic testing before stress‐incontinence surgery” (N Engl J Med. 2012 May 24;366(21):1987–1997) From the Italian Society of Urodynamics

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