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The Miniarc? sling system in the treatment of female stress urinary incontinence
Gauruder-Burmester, Annett;Popken, Gralf;
International braz j urol , 2009, DOI: 10.1590/S1677-55382009000300010
Abstract: aims: to assess the technical feasibility of a new mini-invasive sling procedure (miniarc?) and present short-term results in the treatment of female urinary incontinence. material and methods: a total of 97 women with mixed or stress urinary incontinence (sui) were treated by placement of the new single-incision sling. pelvic organ prolapse was graded using the pop-q system (pelvic organ prolapse quantification system). preoperative workup included urodynamic evaluation, cough stress test and introital ultrasound. postoperatively, introital ultrasound was performed to determine residual urine and check tape position. quality of life was measured using king's health questionnaire. a voiding diary and pad count served to verify the patients' subjective complaints. results: the miniarc? single-incision sling procedure was the initial intervention in 37 (38.2%) patients and the second intervention in 60 (61.7%) patients with recurrent incontinence. the cough stress test was negative in 79 (83.1%) women 6 weeks after the sling procedure and in 74 (77.8%) at 12 months. de novo urge occurred in 32 (36.8%) women. quality of life was significantly improved at 12-month follow-up in 65 (69.1%) patients (p < 0.001). the number of pads decreased significantly from 2.2 to 0.6 (p < 0.001) after the procedure. one patient developed an hematoma and bladder perforation occurred in another. conclusions: our short-term clinical results suggest that the miniarc? is a safe and effective minimally invasive sling procedure for treating female sui. randomized comparative controlled trials and long-term results are still required to define the role of the new sling system in comparison to established mid-urethral tape techniques for treating incontinence.
Martius flap and anterior vaginal wall sling for correction of urethrovaginal fistula (UVF) associated with stress urinary incontinence (SUI) after vaginal delivery
AM Abdelbary
African Journal of Urology , 2012,
Abstract: Objective: To determine the efficacy, safety and urodynamic effects of the Martius flap and the anterior vaginal wall sling in treating post-birth trauma in the form of urethra-vaginal fistula (UVF) associated with stress urinary incontinence (SUI). Patients and methods: Between July 2006 and August 2011, 19 patients underwent repair of UVF by interposition of a Martius flap and correction of associated SUI by a modified anterior vaginal wall sling. The procedure was carried out 3–17 (mean 7) months after post-birth trauma. Pre-operative evaluation consisted of history, voiding diary, physical examination, routine laboratory work-up, abdominopelvic ultrasonography, intravenous urography (IVU), and cystourethrography. The patients were followed up for a mean of 34 months. Follow-up included history, physical examination, urine analysis and pelvic ultrasonography for the assessment of residual urine. Urodynamic evaluation was performed at 3 months post-operatively. Results: None of the patients developed recurrence of UVF. SUI was corrected in 16 patients (84%). In the post-operative period, 3 patients (16%) complained of an overactive bladder (OAB) with urodynamic detrusor overactivity (DO) and an obstructed flow. These problems were managed successfully using anticholinergics and urethral dilation. Three patients (16%) complained of mild SUI, but refused further management.Within 3 years following the intervention, 3 patients complained of a recurrence of SUI which was managed successfully by a rectus sheath sling. KEYWORDS: Urethrovaginal fistula; SUI; Martius flap; Anterior vaginal wall sling; Birth trauma
SUS (Sub Urethral Support) FOR THE CORRECTION OF STRESS URINARY INCONTINENCE: TOWARDS MORE AND MORE SIMPLIFIED SURGERY
D. Piroli Torelli,L. Di Piazza,M. Polichetti,D. Di Piazza
Urogynaecologia International Journal , 2010, DOI: 10.4081/uij.2008.3.5
Abstract: TVT and TOT are considered the gold standard approach for surgical correction of stress urinary incontinence (SUI). In view of the technical difficulties and severe complications sometimes encountered while performing these operations, many authors have studied new, simplified and safer surgical approaches. The aim of this paper is to evaluate the efficacy and validity of the SUS (Sub Urethral Support) technique. SUS represents new mini-invasive surgery for the correction of SUI, and it consists in applying a short sub-urethral sling in a tension-free fashion, through a single vaginal incision.
Contasure needleless: TOT de una sola incision para el tratamiento de la incontinencia de urinaria de esfuerzo
Navazo,Rafael; Moreno,Jesús; Hidalgo,Cristina; Herraiz,Miguel ángel; Vidart,José Antonio; Salinas,Jesús; Silmi,Angel;
Archivos Espa?oles de Urología (Ed. impresa) , 2009, DOI: 10.4321/S0004-06142009000900005
Abstract: objectives: the aim of this study is to describe the surgical technique, and assess the complications and middle-term results of the contasure needle-less (neomedic international), a single incision tot sling for the surgical treatment of stress urinary incontinence. the main concept of this device is that it is not a mini-sling, it has 138% more surface area. we are analyzing the results of a minimally invasive solution that is a tot like sling with the same known benefits of a tot and the advantages of a single incision technique. the surface area to support the urethra of the needleless is very similar to the surface area of the tot. (16% less surface area of tissue ingrowths) it is 100% macroporous polypropylene without any additional material. methods: 120 patients were evaluated retrospectively. they were all treated of sui with the contasure needleless. female patients were evaluated under clinical study protocol consisting in cough test, urodynamic and quality of life questionnaire, before and after the procedure. inclusion criteria: patients with genuine sui and patients with sui plus concomitant procedures as prolapse. exclusion criteria: patients with isd and or neurogenic incontinence. anesthesia used: general (30%) or epidural (70%), patients with associated pathology. procedure: the 114 mm long and tension-free mesh was placed beneath the midurethra. the central part is 12mm wide. the sling can be repositioned during surgery due to the 22mm wide t-pocket positioning system located at the 2 edges. these pockets fixed the sling to the surrounding tissue in order to have the proper tissue in growth and anchoring. a 20mm sub urethral incision was made to dissect the paraurethral spaces only up to the ischiopubic ramus. a surgical forceps with the t-pocket folded was inserted into the dissected spaces and penetrates at the contra lateral side, like the standard transobturator technique. the forceps was introduced until the fascia of the internal obturator m
Mini-Arc for the Treatment of Female Stress Urinary Incontinence: Long-Term Prospective Evaluation by Patient Reported Outcomes  [PDF]
Rui Oliveira,Alexandre Resende,Carlos Silva,Paulo Dinis,Francisco Cruz
ISRN Urology , 2014, DOI: 10.1155/2014/659383
Abstract: Single-incision slings were introduced in the surgical treatment of female stress urinary incontinence (SUI) to lessen the morbidity associated with traditional midurethral slings. However, long-term reports on patient satisfaction are still scarce. This study describes the outcome of women treated with Mini-Arc at a mean follow-up of 45 months. In a previous report on 105 women with 15-month mean follow-up, 84 (80%) were found cured and 12 (11%) improved. Now, with a mean follow-up of 45 months, cured/improved patients were reassessed by telephone and completed Patient Global Impression of Improvement (PGI-I), Patient Global Impression of Severity (PGI-S), rated their improvement in a 0–100 scale, and answered if they would recommend the procedure. At 45-month follow-up, 73 women cured/improved were available for evaluation. Over 80% of the cured patients rated the improvement of SUI by the PGI-I as “very much better” or “much better,” reported their urinary tract condition to be “normal” on PGI-S, and described their improvement >70%. Ninety percent would recommend this procedure to a friend. The improved-patient population is very small . This study shows that the majority of patients cured/improved after Mini-Arc placement maintain a high degree of satisfaction at a long-term evaluation. 1. Introduction According to the European Association of Urology Guidelines on Urinary Incontinence, concerning the treatment of female stress urinary incontinence (SUI), the retropubic insertion of a midurethral synthetic sling (MUS) gives equivalent patient-reported cure of SUI at 12 months, when compared to colposuspension [1]. These guidelines also report that midurethral synthetic sling inserted by either the transobturator (TO) or retropubic (RP) route gives equivalent patient-reported outcome at 12 months [1]. With an obvious trending towards less and less invasive surgical options, single-incision vaginal slings (SIS) have emerged. They require very limited intracorporeal dissection, proposing to further increase safety of suburethral slings, without jeopardizing the success rates reported by conventional RP and TO access [2]. These SIS outcomes are comparable with conventional MUS at short-term follow-up [3–5]. Although sparse, two-year follow-up studies are available and seem to maintain steady success rates over this time [6, 7]. Longer follow-up time reports are needed, to ensure that, in the long run, these SIS offer constant success rates. The objective of this study is to describe the outcome of women treated with Mini-Arc at a mean follow-up of 45
Surgical technique using AdVance? Sling placement in the treatment of post-prostatectomy urinary incontinence
Rapp, David E.;Reynolds, W. Stuart;Lucioni, Alvaro;Bales, Gregory T.;
International braz j urol , 2007, DOI: 10.1590/S1677-55382007000200015
Abstract: objectives: to describe and illustrate a new minimally invasive approach to the treatment of male stress urinary incontinence following prostatectomy. surgical technique: our initial experience consisted of four patients treated with the advance sling for post-prostatectomy urinary incontinence. sling placement involves the following steps: 1. urethral dissection and mobilization, 2. identification of surgical landmarks, 3. placement of needle passers through the obturator foramen, 4. mesh advancement, 5. mesh tensioning and fixation, 6. incision closure. comments: based on our initial experience, we believe that the advance male sling system may be a safe technique for the treatment of male stress urinary incontinence. this technique is easy to perform and may offer a reproducible, transobturator approach. further patient accrual is ongoing to assess the safety and reproducibility of this technique. also, additional study will focus on efficacy standards and complication rates.
Safyre?: a readjustable minimally invasive sling for female urinary stress incontinence
Palma, Paulo C.R;Riccetto, Cassio L.Z;Dambros, Míriam;Thiel, Marcelo;Fraga, Rogério De;Netto Jr, Nelson R;
International braz j urol , 2003, DOI: 10.1590/S1677-55382003000400012
Abstract: introduction: safyre? is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (sui). it is as a pubovaginal sling placed in the medial third of the urethra. the initial experience is described. materials and methods: forty-five patients (mean age = 59 years) underwent a safyre? implant to treat sui. physical examination and urodynamic study were performed before surgery. all patients presented symptoms of sui and 20% also reported mild urgency. approximately 60% of this group had a previously failed anti-incontinence procedure. urethral hypermobility was diagnosed in 40% of the patients and intrinsic sphincter deficiency (isd) in 60% of the cases. results: the average follow up period was 10 months. the mean operative time was 20 minutes. dystopia repair was performed whenever necessary, during the same procedure. the average hospital stay was 24 hours. in 11% of the implants, bladder perforation occurred. during the postoperative period, 9 patients (20%) developed transient urgency symptoms. during the initial follow up period, 90% were found to be continent, 3% reported an improvement and 7% were unchanged. conclusion: safyre? is a safe and quick procedure that allows postoperative readjustment. this technique may be an attractive alternative in the management of sui, should the good result obtained so far prove to be long lasting.
Safyre : a readjustable minimally invasive sling for female urinary stress incontinence  [cached]
Palma Paulo C.R,Riccetto Cassio L.Z,Dambros Míriam,Thiel Marcelo
International braz j urol , 2003,
Abstract: INTRODUCTION: SAFYRE is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. MATERIALS AND METHODS: Forty-five patients (mean age = 59 years) underwent a SAFYRE implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20% also reported mild urgency. Approximately 60% of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40% of the patients and intrinsic sphincter deficiency (ISD) in 60% of the cases. RESULTS: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11% of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20%) developed transient urgency symptoms. During the initial follow up period, 90% were found to be continent, 3% reported an improvement and 7% were unchanged. CONCLUSION: SAFYRE is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.
The Retrourethral Transobturator Sling Suspension in the Treatment of Male Urinary Stress Incontinence: Results of a Single Institution Experience  [PDF]
Johannes Mueller,Andres Jan Schrader,Thomas Schnoeller,Friedemann Zengerling,Ilija Damjanoski,Andreas Al Ghazal,Mark Schrader,Florian Jentzmik
ISRN Urology , 2012, DOI: 10.5402/2012/304205
Abstract: Objective. To evaluate functional outcome of the retrourethral transobturator sling suspension (RTS) in the treatment of stress urinary incontinence (SUI) caused by prior prostate surgery. Methods. The RTS (AdVance male sling) was implanted in 32 patients who suffered from mild to severe postsurgical-treatment incontinence at the University Hospital Ulm from September 2010 to September 2011 including 10 patients with prior radiation therapy. Functional data (uroflowmetry, daily pad use, and postvoid residual urine) as well as quality of life with impact of urinary problems (ICIQ-UI SF) were prospectively assessed at baseline and during followup. Results. After a median followup of 9 months (range, 3–14) the incontinence cure rate (no pad usage) was 56.2% and the improvement rate (1-2 pads/day or ≥50% reduction) was 21.9%. No improvement was observed in 21.9%. Daily pad use and ICIQ-UI SF score improved significantly. No major perioperative complications occurred. Postoperatively, 15.6% of the patients exhibited transient acute urinary retention which resolved without further treatment after a maximum of 3 weeks. One patient underwent sling explantation due to dislocation and persistent perineal pain. Conclusions. The implantation of the RTS is a safe and effective procedure in selected patients with SUI resulting from prostate surgery. 1. Introduction Radical prostatectomy is regarded as the gold standard surgical treatment for organ confined prostate cancer. Even though the surgical technique has been improved steadily stress urinary incontinence is a well-known side effect of this procedure with reported incidence rates of up to 20% [1, 2]. Another rare reason for postsurgery incontinence is the transurethral resection (TUR) of the prostate [3]. The artificial urinary sphincter is still considered to be the standard surgical treatment for stress incontinence after prostate surgery with good long-term results in terms of continence and quality of life [4, 5]. However, besides patients’ requirement of mental capacity and fine-motor control to operate the implanted pump, the significant reoperation rate ≥35% due to well-known complications such as cuff erosion, infection, or mechanical problems lead to an establishment of minimal invasive sling systems for treatment of urinary incontinence in the last years [6]. The retrourethral transobturator sling suspension (RTS), (AdVance male sling, American Medical Systems, Minnetonka, MN, USA), introduced in 2006, offers a functional approach by relocating the descent proximal urethra into the original anatomic
Mini-invasive collagen sling in the treatment of urinary incontinence due to sphincteric incompetence
Taskinen, Seppo;Fagerholm, Riitta;Rintala, Risto;
International braz j urol , 2007, DOI: 10.1590/S1677-55382007000300014
Abstract: objective: to assess the technical feasibility of mini-invasive sling procedure and present preliminary results in the treatment of urinary incontinence due to sphincteric insufficiency. materials and methods: thirteen patients (6 males, 7 females, 8 with myelomeningocele, 1 with tethered spinal cord, 3 with bladder exstrophy, 1 with epispadias) underwent sling procedure with porcine dermis acellular collagen matrix (pelvilacetm, bard medical, uk). the median age was 15.5 (range 8.9-27.5) years. a suprapubic catheter was inserted for the measurement of leak point pressure during the operation. in females vaginal and in males perineal incision was used for sling insertion. the sling was introduced under cystoscopic control. the sling was not fixed with sutures. the outcomes were reviewed at 1, 6 and 12 month after the operation. results: the median leak point pressure increased from 21.5 (range 5-25) cm h2o to 85 (range 70-100) cm h2o. at 1 month 8 and at 6 months 3 out of 13 patients were dry. at 12 months, none out of 11 patients was completely dry. however, at 12 months some improvement in incontinence was detected in 9 out of 11 patients. two patients had primary failures. one patient got sling erosion to urethra after a tightening attempt. in one patient detrusor overactivity increased after the sling procedure. conclusions: pelvilacetm sling is safe and easy to introduce in both males and females if pelvic floor anatomy is normal. although immediate results were promising in neuropathic incontinence, the results seem to deteriorate to unacceptable low level already during the first year. in exstrophy patients the results are generally poor.
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