, Volume 14, Issue 6, pp 432-436
Date: 25 Nov 2003

A randomized comparison between monofilament and multifilament tapes for stress incontinence surgery

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Abstract

Our objective was to compare monofilament and multifilament tapes positioned without tension at the midurethra for postoperative complications and cure rate. One hundred patients with stress urinary incontinence were randomly allocated into two study groups. Using identical surgical methodology, 50 patients had a monofilament tape inserted at the midurethra using the TVT delivery instrument, and another 50 a multifilament tape using the IVS delivery instrument. The only significant difference between the groups was in the incidence of postoperative urinary retention (p=0.023). Ten patients from the monofilament group required longer than normal (‘normal’ means to the morning of the next day) catheterization, in contrast to only two from the multifilament group. The clinical efficacy of both procedures was equally high. Conclusions were that both tapes appear to be equally effective in the surgical treatment of SUI. The higher incidence of postoperative urinary retention in the monofilament group was most likely caused by the elastic feature of this tape.

Editorial Comment: For many surgeons, the TVT sling has become the standard of care for the treatment of stress urinary incontinence. Since its introduction less than 10 years ago, TVT has become one of the best-studied procedures in gynecology, with many papers demonstrating its consistent efficacy and safety. This paper demonstrates the efficacy and safety of two minimally invasive slings: the original TVT sling, and the IVS procedure. The basic procedure is nearly identical for these two operations, including minimal paraurethral dissection and midurethral placement of a synthetic sling. The main difference is the physical properties of the polypropylene mesh. TVT is a monofilament mesh that has elastic properties. This accounts for its Velcro-like ability to bind to surrounding tissues, which obviates the need to suture the mesh to the rectus fascia. The IVS device utilizes a multifilament weave, which has minimal elasticity and does not bind firmly to the surrounding tissues. The authors demonstrate comparable efficacy and safety, with a significantly higher rate of urinary retention in the TVT group. Larger studies are needed to determine whether this finding is consistent and of clinical significance.