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Retropubic synthetic midurethral slings: Techniques and outcomes

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Abstract

Retropubic midurethral slings have evolved to become one of the standard therapies for treatment of stress urinary incontinence. The current slings can be placed through a small vaginal incision, with minimal dissection, in the ambulatory setting. With improvements in technique, complications are minimal. Although the tension-free vaginal tape has the most prospective data in the literature, the suprapubic arc sling appears to have equal cure and complication rates in shorterterm studies. Other retropubic slings have a paucity of data, and long-term equivalency studies have yet to be reported. This article describes the techniques of the most commonly performed retropubic synthetic slings and reports on efficacy and outcomes based on recently published studies.

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References and Recommended Reading

  1. 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, 7:81–86.

    Article  CAS  Google Scholar 

  2. Duckett JR, Grapsas P, Eaton M, Basu M: The effect of spinal anaesthesia on urethral function. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:257–260.

    Article  PubMed  Google Scholar 

  3. Nilsson CG, Palva K, Rezapour M, Falconer C: Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence. Int Urogynecol J 2008, 19:1043–1047.

    Article  CAS  Google Scholar 

  4. Liapis A, Bakas P, Creatsas G: Long-term efficacy of tensionfree vaginal tape in the management of stress urinary incontinence in women: efficacy at 5- and 7-year follow-up. Int Urogynecol J 2008, 19:1509–1512.

    Article  CAS  Google Scholar 

  5. Ward K, Hilton P, UK; Ireland TVT Trial Group: Tensionfree vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 2008, 115:226–233.

    Article  PubMed  CAS  Google Scholar 

  6. Andonian S, Chen T, St-Denis B, Corcos J: Randomized clinical trial comparing suprapubic arch sling (SPARC) and tension-free vaginal tape (TVT): one-year results. Eur Urol 2005, 47:537.

    Article  PubMed  Google Scholar 

  7. Nazemi TM, Yamada B, Govier FE, et al.: Minimum 24-month followup of the sling for the treatment of stress urinary incontinence. J Urol 2008, 179:596–599.

    Article  PubMed  Google Scholar 

  8. Primus G: One year follow-up on the SPARC sling system for the treatment of female urodynamic stress incontinence. Int J Urol 2006, 13:1410–1414.

    Article  PubMed  Google Scholar 

  9. Rodriquez LV, Raz S: Prospective analysis of patients treated with a distal urethral polypropylene sling for symptoms of stress urinary incontinence: surgical outcome and satisfaction determined by patient driven questionnaires. J Urol 2003, 170:857–863.

    Article  Google Scholar 

  10. Rutman M, Itano N, Deng D, et al.: Long-term durability of the distal urethral polypropylene sling procedure for stress urinary incontinence: minimum 5-year followup of surgical outcome and satisfaction determined by patient reported questionnaires. J Urol 2006, 175:610–613.

    Article  PubMed  Google Scholar 

  11. Lee JH, Kim KH, Lee HW, et al.: Distal urethral polypropylene sling surgical management for urodynamic stress incontinence in Korean women. Urol Int 2009, 82:191–195.

    Article  PubMed  Google Scholar 

  12. Paick JS, Oh SJ, Kim SW, Ku JH: Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women. Int Urogynecol J 2008, 19:123–129.

    Article  Google Scholar 

  13. Panayi DC, Duckett J, Digesu GA, et al.: Pre-operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence. Neurourol Urodynam 2009, 28:82–85.

    Article  CAS  Google Scholar 

  14. Botros SM, Miller JR, Goldberg RP, et al.: Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slings. Neurourol Urodynam 2007, 26:42–45.

    Article  Google Scholar 

  15. Schierlitz L, Dwyer PL, Rosamilia A, et al.: Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol 2008, 112:1253–1261.

    PubMed  Google Scholar 

  16. Jeon MJ, Jung HJ, Chung SM, et al.: Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency. Am J Obstet Gynecol 2008, 199:76.e1–76.e4.

    Article  Google Scholar 

  17. Araco F, Gravante G, Sorge R, et al.: TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence. Int Urogynecol J 2008, 19:917–926.

    Article  CAS  Google Scholar 

  18. Constantini E, Lazzeri M, Giannantoni A, et al.: Preoperative Valsalva leak point pressure may not predict outcome of mid-urethral slings. Analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings. International Braz J Urol 2008, 34:73–83.

    Google Scholar 

  19. Holmgren C, Nilsson S, Lanner L, Hellberg D: Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence: a long-term follow-up. Eur J Obstet Gynecol Reprod Biol 2007, 132:121–125.

    Article  PubMed  Google Scholar 

  20. Goldman HB: Simple sling incision for the treatment of iatrogenic urethral obstruction. Urology 2003, 62:714–718.

    Article  PubMed  Google Scholar 

  21. Laurikainen E, Valpas A, Kivela A, et al.: Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol 2007, 109:4–11.

    PubMed  Google Scholar 

  22. Latthe P, Foon R, Toozs-Hobson P: Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG 2007, 114:522.

    Article  PubMed  CAS  Google Scholar 

  23. Kuuva N, Nilsson CG: A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 2002, 81:72–77.

    Article  PubMed  Google Scholar 

  24. Swartz, MA, Ching CB, Gill BC, et al.: Risk of infection after mid-urethral sling surgery: are postoperative antibiotics necessary? [abstract AUA452]. Presented at the American Urological Association Annual Meeting. Chicago, IL; April 25–30, 2009.

  25. Frenkl TL, Rackley RR, Vasavada SP, Goldman HB: Management of iatrogenic foreign bodies of the bladder and urethra following pelvic floor surgery. Neurourol Urodynam 2008, 27:491–495.

    Article  Google Scholar 

  26. Ingber MS, Firoozi F, Desai M, et al.: Single-port transvesical excision of foreign body [abstract AUAV2191]. Presented at the American Urological Association Annual Meeting. Chicago, IL; April 25–30, 2009.

  27. McAchran S, Goldman H: Home in 3 hours: contemporary length of stay when using a perioperative care pathway for midurethral sling surgery. Urology 2009 (in press).

  28. Fourie T, Cohen PL: Delayed bowel erosion by tension-free vaginal tape (TVT). Int Urogynecol J Pelvic Floor Dysfunct 2003, 14:362–364.

    Article  PubMed  CAS  Google Scholar 

  29. Celebi I, Gungorduk K, Arc C, et al.: Results of the tensionfree vaginal tape procedure for treatment of stress urinary incontinence: a 5-year follow-up study. Arch Gynecol Obstet 2009, 279:463–467.

    Article  PubMed  Google Scholar 

  30. Chene G, Amblard J, Tardieu AS, et al.: Long-term results of the tension-free vaginal tape (TVT) for the treatment of female stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2007, 134:87–94.

    Article  PubMed  CAS  Google Scholar 

  31. Clemons JL, LaSala CA: The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure. Int Urogynecol J 2007, 18:727–732.

    Article  Google Scholar 

  32. Deffieux X, Donnadieu AC, Porcher R, et al.: Long-term results of tension-free vaginal tape for female urinary incontinence: follow-up over 6 years. Int J Urol 2007, 14:521–526.

    Article  PubMed  Google Scholar 

  33. Kulseng-Hanssen S, Husby H, Schiøtz HA: Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:391–396.

    Article  PubMed  Google Scholar 

  34. Doo CK, Hong B, Chung BJ: Five-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence. Eur Urol 2006, 50:333–338.

    Article  PubMed  Google Scholar 

  35. Sinha D, Blackwell A, Moran PA: Outcome measures after TVT for mixed urinary incontinence. Int Urogyn J Pelvic Floor Dysfunct 2008, 19:927–931.

    Article  CAS  Google Scholar 

  36. Dalpiaz O, Primus G, Schips L: SPARC sling system for treatment of female stress urinary incontinence in the elderly. Eur Urol 2006, 50:826–830.

    Article  PubMed  Google Scholar 

  37. Noblett KL, Shen B, Lane FL: Lynx midurethral sling system: a 1-year prospective study on efficacy and safety. Int Urogyn J Pelvic Floor Dysfunct 2008, 19:1217–1221.

    Article  Google Scholar 

  38. Dara: Functional results after the suburethral sling procedure for urinary stress incontinence: a prospective randomized multicentre study comparing the retropubic and transobturator routes. Eur Urol 2007, 51:795–801.

    Article  Google Scholar 

  39. Amaro JL, Yamamoto H, Kawano PR, et al.: Clinical and quality-of-life outcomes after autologous fascial sling and tension-free vaginal tape: a prospective randomized trial. Int Braz J Urol 2009, 35:60–67.

    Article  PubMed  Google Scholar 

  40. Karateke A, Haliloglu B, Cam C, et al.: Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study. Austr N Z J Obstet Gynaecol 2009, 49:99–105.

    Article  Google Scholar 

  41. Rapp DE, Govier FE, Kobashi KC: Outcomes following mid-urethral sling placement in patients with intrinsic sphincter deficiency: comparison of SPARC and Monarc slings. International Braz J Urol 2009, 35:68–75.

    Article  PubMed  Google Scholar 

  42. Wang W, Zhu L, Lang J: Transobturator tape procedure versus tension-free vaginal tape for treatment of stress urinary incontinence. Int J Gynaecol Obstet 2009, 104:113–116.

    Article  PubMed  Google Scholar 

  43. Barber MD, Kleeman S, Karram MM, et al.: Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence. Obstet Gynecol 2008, 111:611–621.

    PubMed  Google Scholar 

  44. Jelovsek JE, Barber MD, Karram MM, et al.: Randomised trial of laparoscopic Burch colposuspension versus tension-free vaginal tape: long-term follow up. BJOG 2008, 115:219–225.

    Article  PubMed  CAS  Google Scholar 

  45. Murphy M, van Raalte H, Mercurio E: Incontinence-related quality of life and sexual function following the tension-free vaginal tape versus the “inside-out” tension-free vaginal tape obturator. Int Urogynecol J 2008, 19:481–487.

    Article  Google Scholar 

  46. Rinne K, Laurikainen E, Kivela A, et al.: A randomized trial comparing TVT with TVT-O: 12-month results. Int Urogynecol J 2008, 19:1049–1054.

    Article  Google Scholar 

  47. Shippey SH, Green IC, Quiroz LH: Midurethral sling outcomes: tension-free vaginal tape versus Pelvilace. Int Urogynecol J 2008, 19:1199–1204.

    Article  Google Scholar 

  48. Barry C, Lim YN, Muller R, et al.: A multi-centre, randomised clinical control trial comparing the retropubic (RP) approach versus the transobturator approach (TO) for tension-free, suburethral sling treatment of urodynamic stress incontinence: the TORP study. Int Urogynecol J 2008, 19:171–178.

    Article  Google Scholar 

  49. Charalambous S, Touloupidis S, Fatles G, et al.: Transvaginal vs transobturator approach for synthetic sling placement in patients with stress urinary incontinence. Int Urogynecol J 2008, 19:357–360.

    Article  CAS  Google Scholar 

  50. McCracken GR, Henderson NA, Ashe RG: Five year follow-up comparing tension-free vaginal tape and colposuspension. Ulster Med J 2007, 76:146–149.

    PubMed  Google Scholar 

  51. Morgan DM, Dunn RL, Fenner DE, et al.: Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape. J Urol 2007, 177:604–609.

    Article  PubMed  Google Scholar 

  52. Porena M, Constantini E, Frea B, et al.: Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol 2007, 52:1481–1491.

    Article  PubMed  Google Scholar 

  53. Lord HE, Taylor JD, Finn JC, et al.: A randomized controlled equivalence trial of short-term complications and efficacy of tension-free vaginal tape and suprapubic urethral support sling for treating stress incontinence. BJU Int 2006, 98:367–376.

    Article  PubMed  Google Scholar 

  54. Wang AC, Lin YH, Tseng LH, et al.: Prospective randomized comparison of transobturator suburethral sling (Monarc) vs suprapubic arc (Sparc) sling procedures for female urodynamic stress incontinence. Int Urogynecol J 2006, 17:439–443.

    Article  CAS  Google Scholar 

  55. Zullo MA, Plotti F, Calcagno M, et al.: One-year follow-up of tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of female stress urinary incontinence: a prospective randomised trial. Eur Urol 2007, 51:1376–1384.

    Article  PubMed  Google Scholar 

  56. Fischer A, Fink T, Zachmann S, et al.: Comparison of retropubic and outside-intransoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol 2005, 48:799–804.

    Article  PubMed  Google Scholar 

  57. Tseng LH, Wang AC, Lin YH, et al.: Randomized comparison of the suprapubic arc sling procedure vs tension-free vaginal taping for stress incontinent women. Int Urogynecol J 2005, 16:230–235.

    Article  Google Scholar 

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Correspondence to Howard B. Goldman.

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Ingber, M.S., Goldman, H.B. Retropubic synthetic midurethral slings: Techniques and outcomes. Curr Urol Rep 10, 375–383 (2009). https://doi.org/10.1007/s11934-009-0059-y

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