Retropubic Single Incision Minisling versus Tension Free Vaginal Tape for Management of Stress Urinary Incontinence : a randomized controlled trial

Abstract

Stress urinary incontinence (SUI) is the predominant type of incontinence affecting approximately 50% of incontinent women. SUI reduces quality of life, causes important social limitations and represents an important economic burden (Hunskaar et al., 2004). According to the International continence society, stress urinary incontinence is defined as “A condition in which involuntary loss of urine on effort or exertion, or on sneezing or coughing” (Abrams et al., 2003). Midurethral slings have revolutionized the surgical management of stress urinary incontinence in women and several procedures for midurethral slings have been reported (Papatsoris et al., 2007). Tension-free vaginal tape (TVT) can stabilize the urethra during straining without modifying urethral mobility (Petros and Richardson, 2005). TVT creates a neopubourethal ligament that anchors the three muscle forces activating urethrovesical closure, including pubococcygeus muscles, longitudinal muscle of the anus and levator plate (Sekiguchi et al., 2009). Recognized complications of retropubic mid-urethral slings include voiding dysfunction and the potential for bowel, bladder, and vascular injuries (Ogah et al., 2011). In 2001, Delorme described a new method of inserting the tape, which passes through the obturator foramen (termed transobturator tape [TOT]), thus theoretically avoiding some of the complications such as bladder perforation (Petros and Richardson, 2010). Clinical trials have demonstrated that transobuturator slings are associated with equivalent subjective cure rates to retropubic slings, with less voiding dysfunction and fewer bladder perforations (Novara et al., 2010). However, transobturator slings have lower objective cure rates and have greater risk of postoperative neurologic symptoms in the obturator region (Richter et al., 2010). To maintain efficacy and patient satisfaction while avoiding such complications, minimally invasive mini-slings have been developed (Neuman, 2007). Mini-slings often are performed as an outpatient surgery, with minimal morbidity, pain, and quick patient recovery (Kennelly and Myers, 2011). Single-incision sling procedure for SUI is meant to be less invasive by avoiding the blind trocar passage through the retropubic or transobturator spaces associated with standard midurethral slings. As such, it has the potential for fewer complications, less postoperative pain, and decreased anesthesia requirements than standard slings. This device can be placed using a retropubic or “U” approach, or a transobturator-like “hammock” approach. Clinical trials evaluating single-incision mini-slings are limited, but one study found similar cure rates between the “U” and hammock approaches with objective and subjective cure rates of 84% and 76%, respectively; however, quality of life and treatment satisfaction favored the “U” approach (Lee et al.,2010). The aim of the current study is to compare the efficacy and safety of retropubic single incision minisling with tension free vaginal tape in the treatment of female stress urinary incontinence. This study was conducted in of Ain Shams University Maternity Hospital and included 48 patients with stress urinary incontinence who were recruited from the urogynecologic outpatient clinic. Patients were randomized to receive either minisling or TVT