INTRODUCTION: Nowadays, mid-urethral slings are considered the gold standard in surgical treatment of female stress urinary incontinence (SUI).
Traditionally this technique has been followed by short inpatient hospitalization and convalescence. From the perspective of both, the patient and the physician, this technique has become increasingly popular due to very high clinical effectiveness and fast recovery.
OBJECTIVES: The aim of the study was to compare the efficacy and safety of transobturator monofilament sling (T-sling-Hernia Mesh, Italy) with additional 2-point tape fixation in the treatment of SUI in women operated on an inpatient and outpatient basis.
MATERIAL AND METHODS: A total of 200 women with stress urinary incontinence were included into the study Clinical diagnosis was based on detailed medical history voiding diary gynecological examination, and positive cough test. Exclusion criteria were as follows: previous urogynecologic surgery detrusor overactivity on urodynamics and advanced urogenital prolapse (pelvic organ prolapse-quantification [POP-Q] scale grades--II, III, IV). In both groups the surgery was performed by two (TR; A W) surgeons. Using identical surgical technique, all patients had a monofilament tape inserted at the mid-urethra with 2 absorbable sutures parallel to the urethra in order to fix the tape and prevent its displacement during tape tensioning. Patients were discharged home after the first spontaneous voiding (outpatient group) or 2 days (inpatient group) postoperatively After 12 months, 192 patients (99 in outpatient and 93 in inpatient group) were available for assessment of clinical effectiveness of surgery Success was defined as lack of any leakage during cough stress test. The subjective cure rate was determined by Sandvik scale also after 12 months. Statistical analysis was performed with Statistica 7.1 pl and Mann-Whitney U and Chl tests were used. P-level of < or = 0.05 was considered as statistically significant.
RESULTS: There were no differences in demographical data of patients from both groups. The only difference between the two groups concerned the body mass index (mean 26.6 +/- 3.9 vs. 28.67 +/- 3.99; p< 0.001) and age (50.48 +/- 9.71 vs. 61.7 +/- 9.2; p< 0.001) in the outpatient versus inpatient group, respectively There was no significant difference between the two groups in terms of the overall patients satisfaction and cure rate after the 12-month follow-up (chi2=4.039, p=0.133).
CONCLUSIONS: Proper surgical technique but not length of hospitalization is the main factor determining the effectiveness of surgical treatment of SUI. Tape fixation is a simple surgical maneuver that ensures proper sling placement at mid-urethra and does not markedly increase procedure duration or cost of the treatment. Outpatient surgery for SUI using transobturator mid-urethral sling ensures the same cure and satisfaction rates as inpatient orocedure. allowing to reduce the cost of the treatment without compromising clinical effectiveness.
Written by:
Wróbel A, Rechberger T, Winkler I, Nowakowski L, Kulik-Rechberger B. Are you the author?
Reference: Ginekol Pol. 2014 Nov;85(11):833-7.
PubMed Abstract
PMID: 25675800
Article in Polish.