Adjustable transobturator sling as the first-line surgical treatment of stress urinary incontinence in women

Shkarupa D.D., Kubin N.D., Starosel'ceva O.Yu., Zayceva A.O., Pisarev A.V., Shapovalova E.A.

Aim: To evaluate the results of stress urinary incontinence (SUI) treatment using a transobturator adjustable sling.

Materials and methods: The study included 227 women with SUI, who were divided into 2 groups: uncomplicated SUI (group 1, n=157) and complicated SUI (group 2, n=70). All patients underwent the transobturator adjustable midurethral tape placement. The postoperative evaluation included medical history, vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR) urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12) and visual analogue scale (VAS).

Results: Mean operative time was 13,93±6,48 min. One day after surgery 41,40% (65/157) women of 1 group and 64,28% (45/70) women of 2 group needed tension readjustment. After adjustment, all patients were continent without any signs of infravesical obstruction. After 12-month follow-up, there was no significant decrease of Qmax and Qave (p>0,5). There were no cases of wound infections, vaginal mesh extrusion or urinary obstruction. Objective cure rate was 95,59% (96,17% for group 1 patients and 94,28% for those with complicated SUI). According to the questionnaires scores, 97,35% noted significant improvement of postoperative quality of life (p<0,001).

Conclusion: Our method of transobturator adjustable sling placement neither complicates the surgery nor increases the operation time. It allows the surgeon, even with a little experience, to achieve better results and to avoid serious complications, such as obstructive voiding and urinary retention. The adjustable systems, such as presented, can be recommended as the first-line surgical treatment for female SUI.

Authors declare lack of the possible conflicts of interests.

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stress urinary incontinence, midurethral sling, adjustable sling, urinary obstruction, synthetic tape, mesh implants

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