Abstract
Introduction and hypothesis
Over 50 different types of midurethral slings have been marketed. They have generally been considered comparable in performance. Many studies have compared retropubic with obturator slings, but few have compared different makes of retropubic slings with each other. We have compared the performance of retropubic slings using data from the Norwegian Female Incontinence Registry.
Methods
From June 2015 through 2017, 2843 women underwent a retropubic sling procedure, with 6–12-month follow-up data available for 2612 (92%). Results for six different types of slings used in this time period are presented: TVT Exact, TVT Classic, Advantage, Advantage Fit, TVT A.M.I. and RetroArc. The TVT Exact was the most prevalent sling, and the outcomes were compared with this sling as reference using chi-square and Dunnet’s tests with significance at 0.05.
Results
There were only small differences among the four slings, TVT Exact, TVT Classic, Advantage and Advantage Fit, with subjective cure rates from 77.7 to 81.9% and objective cure rates from 90.8 to 96.6%. The TVT A.M.I. sling had a high cure rate but significantly fewer satisfied patients and less improvement in urgency bother. The Retro Arc’s results were clearly inferior. There was little difference in terms of obstruction or de novo urgency incontinence among the six slings. Most complication rates were not statistically different.
Conclusions
At 6–12-month follow-up there was no significant difference in clinical results between the TVT Exact, TVT Classic, Advantage and Advantage Fit slings, while RetroArc and to some extent TVT A.M.I. slings underperformed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:Art. No.: CD006375. https://doi.org/10.1002/14651858.CD006375.pub4.
Rovner E, Athanasiou S, Choo M-S, Cosson M, Dmochowski R, Gomelsky A, et al. Surgery for urinary incontinence in women. In: Abrams P, Cardozo L, Wagg A, et al., editors. Incontinence 6th edition.; 2017. p. 1743–854. www.ics.org.
Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J. 1996;7:81–6.
Ostergard DR. Lessons from the past: directions for the future. Do new marketed surgical procedures and grafts produce ethical, personal liability, and legal concerns for physicians? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:591–8.
Dwyer PL. The 75% rule: all stress incontinence procedures are alike. Int Urogynecol J. 2011;22:769–70.
Slack M, Ostergard D, Cervigni M, Deprest J. A standardized description of graft-containing meshes and recommended steps before the introduction of medical devices for prolapse surgery. Int Urogynecol J. 2012;23(Suppl 1):S15–26.
Chapple C, Raz S, Brubaker L, Zimmern PE. Mesh sling in an era of uncertainty: lessons learned and the way forward. Eur Urol. 2013;64:525–9.
Hogewoning CRC, Gietelink L, Pelger RCM, Hogewoning JA, Bekker MD, Elzevier HW. The introduction of mid-urethral slings: an evaluation of literature. Int Urogynecol J. 2015;26:229–34.
Moalli PA, Papas N, Menefee S, Albo M, Meyn L, Abramowitch SD. Tensile properties of five commonly used mid-urethral slings relative to the TVT. Int Urogynecol J. 2008;19:655–63.
Moldovan CP, Marinone ME, Staack A. Transvaginal retropubic sling systems: efficacy and patient acceptability. Int J Women's Health. 2015;7:227–37.
NKIR https://www.kvalitetsregistre.no/registers/norsk-kvinnelig-inkontinensregister.
Kulseng-Hanssen S, Borstad E. The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence. BJOG. 2003;110:983–8.
Berild GH, Kulseng-Hanssen S. Reproducibility of a cough and jump stress test for the evaluation of urinary incontinence. Int Urogynecol J. 2012;23:1449–53.
Thubert T, Canel V, Vinchant M, Wignoiolle I, Fernandez H, Deffieux X. Bladder injury and success rates following retropubic mid-urethral sling: TVT EXACT™ vs: TVT™; 2016.
Pergialiotis V, Mudiaga Z, Perrea DN, Doumouchtsis SK. De novo overactive bladder following midurethral sling procedures: a systematic review of the literature and meta-analysis. Int Urogynecol J. 2017;28:1631–8.
Stanford EJ, Paraiso MFR. A comprehensive review of suburethral sling procedure complications. J Minim Invasive Gynecol. 2008;15:132–45.
Ghoniem G, Stanford E, Kenton K, Achtari C, Goldberg R, Mascarenhas T, et al. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J. 2008;19:5–33.
Acknowledgements
We are grateful for the help given us by statistician Petter Mowinkel, MSc, Oslo University Hospital.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Supplementary Table 1
(DOCX 18 kb)
Rights and permissions
About this article
Cite this article
Schiøtz, H.A., Svenningsen, R. & Kulseng-Hanssen, S. Comparison of retropubic midurethral slings in the treatment of female stress urinary incontinence. Int Urogynecol J 31, 711–716 (2020). https://doi.org/10.1007/s00192-019-04080-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-019-04080-y