Midurethral slings versus the standard pubovaginal slings for women with neurogenic stress urinary incontinence

Introduction and hypothesis Preliminary reports show promising data on tension-free vaginal tape (TVT) in women with lower motor neuron lesion (LMNL) presenting with stress urinary incontinence (SUI). We compared efficacy and safety of TVT to pubovaginal sling (PVS) in treating SUI in women with LMN...

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Published in:	International Urogynecology Journal 2015-03, Vol.26 (3), p.427-432
Main Authors:	El-Azab, Ahmed S., El-Nashar, Sherif A.
Format:	Article
Language:	eng
Subjects:	Adult Fasciotomy Female Gynecology Humans Medicine Medicine & Public Health Meningomyelocele - complications Middle Aged Original Article Pilot Projects Sacrum Severity of Illness Index Spinal Cord Injuries - complications Spinal Cord Neoplasms - complications Suburethral Slings - adverse effects Surgical Mesh - adverse effects Treatment Failure Urinary Bladder, Neurogenic - etiology Urinary Bladder, Neurogenic - surgery Urinary Incontinence, Stress - etiology Urinary Incontinence, Stress - surgery Urology Young Adult
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Summary:	Introduction and hypothesis Preliminary reports show promising data on tension-free vaginal tape (TVT) in women with lower motor neuron lesion (LMNL) presenting with stress urinary incontinence (SUI). We compared efficacy and safety of TVT to pubovaginal sling (PVS) in treating SUI in women with LMNL. Methods This was a pilot, nonrandomized clinical trial evaluating women with SUI associated with pathology at or below S2 spinal segment. Failure was defined as leakage of urine during cough test at 250 ml bladder volume. Primary outcome was time to treatment failure based on positive cough stress test. Other outcomes were Urogenital Distress Inventory Short Form-6 (UDI-6), Incontinence Impact Questionnaire Short Form-7 (IIQ-7) and urodynamics. Regression models were used to adjust for confounders. Results The study evaluated 40 women: 20 TVT and 20 PVS, and cure rates were 80 and 85 %, respectively. Time to treatment failure in the TVT group was comparable with the PVS group, with an unadjusted hazard ratio (HR) of 2.90 [95 % confidence interval (CI), 0.61–15.42, P = 0.154]. After adjusting for confounders, adjusted HR for treatment failure was 1.04 (95 % CI, 0.12–8.66, likelihood ratio chi-square P = 0.973). Both groups showed significant reductions in UDI-6 and IIQ-7 scores after surgery. One patient had mesh erosion in the TVT group. Conclusions TVT is feasible, effective and safe for women with LMNL presenting with SUI, with comparable treatment outcomes to PVS. TVT might be of benefit to women who do not use clean intermittent catheterization (CIC) at baseline.
ISSN:	0937-3462 1433-3023