M Basu1, J Duckett. 1. Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK. mayabasu@aol.com
Abstract
OBJECTIVE: To compare a mini-sling with a retropubic tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) and urodynamic stress incontinence (USI). DESIGN: Randomised trial. SETTING:Urogynaecology unit in large UK district general hospital. POPULATION: Women with USI resistant to conservative management and requiring a suburethral sling. METHODS: A total of 71 women with SUI and confirmed USI were randomised to undergo treatment with either a retropubic TVT or mini-sling. Follow-up was at 6 weeks, with a history, examination and quality of life questionnaire, and at 6 months with further subjective evaluation and twin-channel subtraction cystometry and pressure-flow studies. MAIN OUTCOME MEASURES: The presence of SUI at 6 weeks and 6 months after treatment. RESULTS: The mini-sling was associated with a significantly higher rate of persistent SUI at 6 weeks (OR 9.49, 95% CI 2.8-32.6) and 6 months (OR 8.14, 95% CI 2.7-24.7), and of USI at 6 months (OR 7.58, 95% CI 2.7-24.7). The rate of complication was similar in the two groups. CONCLUSIONS: The mini-sling is associated with a higher failure rate than a retropubic TVT. Longer term and multicentre outcome data are necessary to explore these findings further. Until this is available, the mini-sling should be used with caution.
RCT Entities:
OBJECTIVE: To compare a mini-sling with a retropubic tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) and urodynamic stress incontinence (USI). DESIGN: Randomised trial. SETTING: Urogynaecology unit in large UK district general hospital. POPULATION: Women with USI resistant to conservative management and requiring a suburethral sling. METHODS: A total of 71 women with SUI and confirmed USI were randomised to undergo treatment with either a retropubic TVT or mini-sling. Follow-up was at 6 weeks, with a history, examination and quality of life questionnaire, and at 6 months with further subjective evaluation and twin-channel subtraction cystometry and pressure-flow studies. MAIN OUTCOME MEASURES: The presence of SUI at 6 weeks and 6 months after treatment. RESULTS: The mini-sling was associated with a significantly higher rate of persistent SUI at 6 weeks (OR 9.49, 95% CI 2.8-32.6) and 6 months (OR 8.14, 95% CI 2.7-24.7), and of USI at 6 months (OR 7.58, 95% CI 2.7-24.7). The rate of complication was similar in the two groups. CONCLUSIONS: The mini-sling is associated with a higher failure rate than a retropubic TVT. Longer term and multicentre outcome data are necessary to explore these findings further. Until this is available, the mini-sling should be used with caution.
Authors: Annetta M Madsen; Sherif A El-Nashar; Joshua L Woelk; Christopher J Klingele; John B Gebhart; Emanuel C Trabuco Journal: Int Urogynecol J Date: 2013-09-17 Impact factor: 2.894
Authors: Aimee L Tieu; Aparna Hegde; Peter A Castillo; G Willy Davila; Vivian C Aguilar Journal: Int Urogynecol J Date: 2016-10-06 Impact factor: 2.894