Choice of Surgery for Stress Incontinence. Experience After 295 Suburethral Sling Procedures

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Choice of Surgery for Stress Incontinence. Experience After 295 Suburethral Sling Procedures

Choice of Surgery for Stress Incontinence. Experience After 295 Suburethral Sling Procedures

Samuel BADALIAN MD

New York, Syracuse
Urogynecology

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* Date : 05-07-2008 - 12:42 AM (10 days ago),

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Choice of Surgery for Stress Incontinence. Experience After 295 Suburethral Sling Procedures

Samuel S. Badalian, M.D., Dr. Med. Sc.

St. Joseph’s Hospital Health Center; SUNY Upstate Medical University, Syracuse, New York

OBJECTIVE: To compare the effectiveness, clinical outcome, and safety of tension-free vaginal tape (TVT-Gynecare) and transobturator tape (TOT-Monarc) in the
treatment of stress urinary incontinence.
METHODS: A retrospective chart review was performed from December 1999 to December 2005 on 295 women who underwent a tension-free vaginal tape or transobturator tape procedure for stress incontinence. Only one surgeon performed both procedures. Before surgery all patients underwent a comprehensive history and urogynecological evaluation.
RESULTS: One hundred twenty-four patients underwent the tension-free vaginal tape procedure, and 171 patients had the transobturator tape–approach suburethral sling performed because of stress urinary incontinence. No significant difference was found between the tension-free vaginal tape and transobturator tape groups in the subjective cure rate (91% versus 86.5%), improvement rate (7.2% versus 10.5%), and failure rate (1.6% versus 3%) (P=0.675). Intraoperative complications, including only five perforations of the bladder, occurred in the tension-free vaginal tape group, compared to no injuries in the transobturator tape group. The median operating time in the tension-free vaginal tape group was 24 minutes compared with 13 minutes for the transobturator tape approach.
CONCLUSION: The analyzed series revealed that approximately 96% had cured or improved continence status after a suburethral sling procedure in the treatment of female stress incontinence, independent of the type of sling used. Considering the similar results of the procedures, we favor the TOT (Monarc) because of its lower incidence of complications and simpler technique of placement.

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