Autologous transobturator midurethral sling (original) (raw)
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Journal of Reconstructive Urology, 2018
The goal of this study is describe mid-urethral sling surgery without mesh usage to avoid mesh related complications. For this purpose our modified transobturator mid-urethral sling technique with the short-term results was evaluated. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The data of 20 patients performed modified transobturator mid-urethral sling with autologous tissue were recorded. The primary endpoints of this study were improvements in The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) scores and quality of life scores, one-hour pad test measurements, and cough stress tests rates as an objective cure, and Patients Global Impressions of Improvements (PGI-I) scale as a subjective cure. Categorical variables were compared using a paired Student's t-test. R Re es su ul lt ts s: : Twenty patients with a mean age of 50.5±3.3 years and mean body mass index of 28.9±3.9 kg/m 2 , were enrolled in the study. The mean follow-up time was 3.9±0.8 months. Mean operation time was 42.7±7.5 minutes, and complication rates were 1/20 (5%). The mean PGI-I score was 2 postoperatively which means much better than preoperatively. The positive cough test rate and one-hour pad weight gain were statistically lower postoperatively. The decreases of subscores and quality of life scores of the incontinence section were statistically significant. The total ICIQ-FLUTS score and quality of life scores were significantly reduced in the postoperative period. C Co on nc cl lu us si io on n: : To avoid mesh related complications of mid-urethral sling surgeries, our modified transobturator mid-urethral sling technique is a feasible option for patients and surgeons with its short-term effectiveness and safety profile. K Ke ey yw wo or rd ds s: : Stress urinary incontinence; autograft; midurethral sling surgery; mesh; autologous fascial sling Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada, stres üriner inkontinans tedavisinde sentetik meşlerle ilişkili komplikasyonlardan kaçınabilmek için sentetik meş kullanmadan midüretral askı cerrahisi tanımlanmak istenmiştir. Bu amaçla modifiye otolog transobturator midüretral askı cerrahisi (m-OTOT) tekniğimizin kısa dönem sonuçları sunulmuştur. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : m-OTOT uygulanan 20 hastanın preop ve postop "The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS)" skorları, 1 saatlik ped testi ölçümleri, stres testi sonuçları, yaşam kalitesi ölçeği (QoL) ve postop "Patients Global Impressions of Improvements (PGI-I)" skalasını içeren datalar toplandı. Kategorik değişkenler, eşleştirilmiş bir Student t-testi kullanılarak karşılaştırıldı. B Bu ul lg gu ul la ar r: : Yaş ortalaması 50,5±3,3, beden kitle endeksi 28,9±3,9 kg/m 2 olan 20 hastanın ortalama takip süresi 3,9±0,8 aydır. Ortalama ameliyat süresi 42,7±7,5 dakika ve komplikasyon oranı 1/20 (%5) (lokal tedavi ile iyileşen vajinal erozyon)'dir. PGI-I skoru 2 olarak belirtilmiştir ve ameliyat öncesine göre daha iyi olma durumunun karşılığıdır. Pozitif stres test oranı ve 1 saatlik ped testinde ağrılık artışı oranları postoperatif dönemde anlamlı olarak düşüktü. ICIQ-FLUTS formunda inkontinans bölüm skoru ve inkontinans bölümü yaşam kalitesi skoru postop dönemde anlamlı iyileşme göstermiştir, ayrıca toplam ICIQ-FLUTS skorU ve toplam yaşam kalitesi skoru da anlamlı olarak iyileşmiştir. S So on nu uç ç: : Stres üriner inkontinans cerrahisinde mesh ile ilişkili komplikasyonlarından kaçınmak için, modifiye transobturator orta üretral sling tekniğimiz, kısa süreli etkinliği ve güvenlik profili ile hastalar ve cerrahlar için uygun bir seçenektir.
Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence
Journal of Urology, 2015
Purpose: We describe and evaluate a transobturator approach to urethral sling placement using autologous rectus fascia for the management of female stress urinary incontinence. Materials and Methods: We performed a feasibility study of 10 cases of autologous transobturator mid urethral sling placement for stress urinary incontinence. The procedure includes an anterior vaginal dissection performed in the standard fashion for a mid urethral sling and harvest of a strip of rectus fascia. A trocar is passed through each obturator foramen and the fascial stay sutures are retracted through the skin incisions. The sling is appropriately tensioned and the stay sutures are tied. Patient outcomes were measured by a 24-hour pad weight test and ICIQ-FLUTS score. Results: Median patient age was 57 years (IQR 48, 69.5) and median body mass index was 30.3 kg/m 2 (IQR 25.2, 32.4). Median followup was 4 months (range 3 to 5). All patients demonstrated a reduction in leakage with 80% being completely dry (0 gm on 24-hour pad test and not wearing pads). Overall there was significant improvement in postoperative vs preoperative 24-hour pad weight (p¼0.02). Likewise, all subscores of the ICIQ-FLUTS were significantly improved after surgery, including frequency (p¼0.006), voiding (p¼0.04) and incontinence (p¼0.002). Of the 9 eligible cases 6 (67%) were performed on an outpatient basis. One patient performed intermittent self-catheterization for 24 hours after sling placement. No patients experienced severe (Clavien III-V) postoperative complications or required urethrolysis. Conclusions: Autologous transobturator urethral sling placement appears to be technically feasible with excellent short-term outcomes. Longer followup and larger series are needed for validation.
Autologous transobturator sling as an alternative therapy for stress urinary incontinence
International journal of gynaecology and obstetrics, 2019
To evaluate efficacy and outcomes of the autologous transobturator midurethral sling for treatment of stress urinary incontinence (SUI). Methods: In a prospective cohort study, an autologous transobturator mid-urethral sling was used to treat SUI among women attending a university hospital in Montevideo, Uruguay, from June 2017 to July 2018. In the first phase, autologous tissue of the abdominis rectus fascia was collected. In the second phase, the midurethral sling was placed via the transobturator approach. Outcomes were measured every 3 months by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score. Preoperative and postoperative results were compared by Wilcoxon test. Results: Eighteen women with a median age of 51 years were enrolled. The median follow-up was 9 months (range 6-15 months). Overall, 17 women showed symptomatic improvement after the procedure. In a comparison of preoperative versus postoperative ICIQ-FLUTS questionnaires, improvement in the incontinence subscore was observed at 3 (P<0.001), 6 (P<0.001), and 12 (P=0.008) months. No severe complications were observed. Conclusion: Use of an autologous transobturator urethral sling was found to be technically feasible and safe for SUI, with good short-term outcomes. Longer follow up and larger series are needed to validate the procedure.
The Kaohsiung Journal of Medical Sciences, 2016
The aim of this study was to compare the clinical outcomes of anti-incontinence surgeries employing the transobturator sling and single-incision sling (SIS). Our hypothesis is that the outcome of the SIS is not inferior to the obturator sling. This retrospective study reviewed the medical records of patients who underwent anti-incontinence surgery with the transobturator sling or SIS from July 2005 to November 2014. Patients who underwent concomitant pelvic organ reconstruction with an artificial mesh were excluded. Assessments included preoperative and postoperative urodynamic examinations, perioperative complications, and postoperative urogenital symptoms. A total of 122 women were recruited according to the inclusion and exclusion criteria. Among them, 68 patients underwent transobturator sling procedures while 54 patients underwent SIS procedures. The subjective failure rate of the transobturator sling and SIS were 10.2% and 18.5%, respectively (p Z 0.292). The objective failure rate, defined as a pad test showing more than 2 g of urine, was 10.2% for the transobturator sling and 12.9% for the SIS (p Z 0.777). SIS resulted in less blood loss, operative time, length of hospital stay, and transient voiding dysfunction after the operation. No major complication occurred after either surgical intervention. In conclusion, SIS and transobturator slings might have similar efficacy, safety, and effects on new-onset urogenital symptoms.
Scandinavian Journal of Urology, 2012
Objective.This article reports the early results of a novel sling used for the treatment of female stress urinary incontinence (SUI). This sling has a piece of autologous rectus fascia in its middle part and two arms of polypropylene mesh. Material and methods. The study included 44 women with SUI. The preoperative work-up involved complete history taking, physical examination, cough stress test (CST) and 1 h pad weight test (PWT). Two questionnaires, the Urogenital Distress Inventory-Short Form (UDI-6) and the Incontinence Impact Questionnaire-Short Form (IIQ-7), were also completed preoperatively. The previously described sling was then inserted via the transobturator route in all patients. Postoperatively, the previous work-up was repeated for objective evaluation of the procedure and the subjective improvement was assessed by the Patient Global Impression of Improvement scale. Results.At the end of the first year, 92.9% of the patients had a negative CST, 85.7% had 1 h PWT <1 g and the subjective cure rate was 90.5%. In addition, the scores for both UDI-6 and IIQ-7 were found to be decreased significantly (p < 0.001). The recorded complications included temporary urinary retention, dyspareunia, de novo urge incontinence and groin pain in 4.8%, 4.8%, 7.1% and 11.9% of patients, respectively. Conclusion. This hybrid sling appears to have good short-term efficacy and low cost.
Al-Azhar Medical Journal, 2020
Background: stress urinary incontinence is a common problem affecting females; treatment varies between Burch colposuspension and traditional tot using synthetic materials. Objective: To evaluate efficacy and safety of autologous transobturator (ATO) rectus fascia sling as a primary treatment for female stress urinary incontinence. Materials and Methods: We evaluated the outcomes of 56 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from July 2017 to September 2019 at the urology departmentAl Azhar university hospitals (Alhussien-Sayed Galal university hospitals). Patients were followed in the outpatient clinic after one week, two weeks, 3 months and 6 months postoperatively. Outcomes were measured subjective by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score, and patient reported outcome and objective by cough stress test. ICIQ-FLUTS were compared between pre-and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method. Results: The mean age of patients was 43.4 ± 7.04 years (29-56 years), 40 patients (71.5%) were premenopausal, and 16 patients (28.5%) were postmenopausal. The mean BMI was 29.2 ± 4.1 kg/m². The technique was performed and the patient was discharged the next day after surgery. Follow up for patients was carried out at one week, two weeks, three and six months postoperatively. All patients completed ICIQ-FLUTS at the last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 6 months (N = 56) showed significant improvement in all domains: frequency, voiding, and incontinence, and in quality of life related to frequency, voiding and incontinence. Among those who completed questionnaires both at 3 months and 6 months after surgery (N = 56). There was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 93% at six months. Notably, none of our patients suffered from severe (Clavien III-V) complications or required sling release. Conclusion: ATO sling placement appeared safe and effective, with promising short-term outcomes. However, long term follow-up is needed.
Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures
Obstetrics & Gynecology, 2019
OBJECTIVE: To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures. METHODS: We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis. The primary outcome was defined as reoperation for recurrent SUI. Secondary outcomes included intraoperative complications and mesh-related complications requiring reoperation after the index sling procedure. RESULTS: We identified 1,881 women who underwent a sling procedure for primary SUI—1,551 retropubic and 330 transobturator. There was no difference between groups in any of the evaluated baseline variables in the covariate-matched cohort of 570 with retropubic slings and 317 with transobturator slings; results herein ar...