Abstract
Two midurethral slings, TVT and Sparc, are the subject of this case–control series aimed at assessing sling placement, voiding function, bladder symptoms and patient satisfaction. Thirty-seven Sparc and 69 TVT patients were matched for age, body weight, pre-existing urge incontinence, preoperative voiding, concomitant surgery and length of follow-up (mean 0.6, range 0.1–1.5 years). There were no significant differences for subjective cure/improvement, satisfaction or symptoms of incontinence. The clinical stress test was positive in 8/37 Sparc vs 4/69 TVT patients (p=0.019). The TVT had a more negative effect (p=0.001) on postoperative voiding. The Sparc was situated more cranially at rest and further from the symphysis pubis, and was more mobile (p<0.001) on Valsalva. There are significant differences in medium-term outcomes after TVT and Sparc, affecting tape placement, mobility, effect on voiding function and objective stress continence. Patient satisfaction and subjective cure rates seem similar.
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Abbreviations
- TVT:
-
Tension-free vaginal tape
References
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The authors thank Johnson & Johnson Medical New Zealand and AMS Australia for financial support of this work.
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Editorial Comment: The authors are to be commended for performing such timely research as clinicians struggle to understand the differences, if any, among the various minimally invasive midurethral slings that have been developed since the original tension-free tape (TVT) procedure. Despite the authors proposed explanation of a ‘pretensioning’ effect, without intraoperative ultrasound measurements of tape displacement before and immediately after sheath removal, several other equally plausible explanations exist. It is also interesting to note the differences in postoperative voiding parameters and objective cure rates that once again remind us of the difficulty in surgically achieving high objective cure rates for stress incontinence without compromising normal outflow during micturition.
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Dietz, H.P., Foote, A.J., Mak, H.L.J. et al. TVT and Sparc suburethral slings: a case–control series. Int Urogynecol J 15, 129–131 (2004). https://doi.org/10.1007/s00192-003-1118-4
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DOI: https://doi.org/10.1007/s00192-003-1118-4