A cohort study comparing a single-incision sling with a retropubic midurethral sling

作者：Madsen Annetta M; El Nashar Sherif A; Woelk Joshua L; Klingele Christopher J; Gebhart John B; Trabuco Emanuel C^*

来源：International Urogynecology Journal and Pelvic Floor Dysfunction, 2014, 25(3): 351-358.

DOI：10.1007/s00192-013-2208-6

• Mini-slings
• Urinary incontinence
• Single incision
• Retropubic slings
• Midurethral slings

Despite established comparable efficacy between retropubic midurethral (RMUS) and transobturator slings, there are conflicting data regarding single-incision mini-slings (SIMS). This study tests the null hypothesis that the MiniArcA (R) Single-Incision Sling is equivalent to the ALIGNA (R) Urethral Support System for treatment of stress urinary incontinence (SUI).
Women who underwent a sling for SUI from 1 January 2008 through 31 December 2009 were identified (N = 324). A follow-up survey was mailed. Primary outcomes were treatment failure, defined as International Consultation on Incontinence Questionnaire (ICIQ) score > 0 or additional anti-incontinence procedure, and stress-specific incontinence (SSI). Secondary outcomes included Patient Global Impression of Severity and Improvement (PGI-SI), satisfaction, de novo urge, and complications.
The study included 202 women who returned the survey. The SIMS group had higher body mass index (BMI) (30.7 +/- 6.5 vs 28.9 +/- 6.0 kg/m(2), P = 0.052) and shorter follow-up (18.6 +/- 11.5 vs 22.9 +/- 14.6 months, P = 0.019). Treatment failure was higher in SIMS compared with RMUS (76.3 % vs 64.2 %) with adjusted odds ratio of 1.84 (95 % CI, 1.0, 3.5). The SIMS group was more likely to have postoperative SSI, with adjusted OR of 2.4 (95 % CI; 1.3-4.5). The RMUS group reported more improvement and satisfaction. Incidence of de novo urge and complications were similar between groups. Reoperation for mesh erosion was more likely in the RMUS group, while the SIMS had a higher reoperation rate for SUI.
Compared with retropubic ALIGNA (R) Slings, MiniArcA (R) Single-Incision Slings are less effective, with more postoperative incontinence, less patient-reported improvement, satisfaction, and higher reoperation rates for SUI.

• 出版日期2014-3