Laparoscopic colposuspension versus vaginal suburethral slingplasty: a randomised prospective trial. Functional results after the suburethral sling procedure for urinary stress incontinence: a prospective randomized multicentre study comparing the retropubic and transobturator routes. Suburethral slingplasty evaluation study in North Queensland, Australia: the SUSPEND trial. Comparison of Burch and lyodura sling procedures for repair of unsuccessful incontinence surgery. Comparison of pubovaginal sling and burch colposuspension procedures in type I/II genuine stress incontinence. Comparative results of two techniques to treat stress urinary incontinence: synthetic transobturator and aponeurotic slings. Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence. A prospective randomized study comparing modified Burch retropubic urethropexy and suburethral sling for treatment of genuine stress incontinence with low-pressure urethra. Randomized comparison of the suprapubic arc sling procedure vs tension-free vaginal taping for stress incontinent women.
This study aimed to determine if laparoscopic colposuspension (LC) was as effective as vaginal suburethral slingplasty (SPARC).
                Ninety-seven women with urodynamic stress incontinence were prospectively randomised to LC (n=48) or SPARC (n=49). Outcome measures were measured at, baseline, six months (n=87) and two years (n=58), and comprised leakage episodes per week and visual analogue scale (VAS) of incontinence severity. The LC and SPARC groups at baseline had similar leaks per week (8.8 vs 9.8) and VAS (5.6 vs 5.9).
                Laparoscopic colposuspension took longer to perform (48 vs 30 mins, P<0.001), had a slightly higher blood loss (104 vs 82 mL, P<0.01), had a longer hospitalisation (4.0 vs 1.5 days, P<0.001) and had a longer time to resumption of normal activities (3.6 vs 2.8 week, P<0.01). At six months there were no significant differences between LC and SPARC with regard to leaks per week (1.1 vs 2.6) and VAS (1.3 vs 0.7). The success rates were similar (88.3 vs 81.8%). These results again had no significant differences at two years (leaks per week 2.1 vs 3.5, and VAS 1.7 vs 2.2). At two years, the cure/improved rates again found no significant difference (81.5 vs 77.4%)
                Laparoscopic colposuspension is as effective as vaginal suburethral slingplasty after two years' follow-up. To compare short-term functional outcomes, urodynamic parameters, and quality of life of transobturator and retropubic routes in the cure of urinary stress incontinence.
                This prospective, multicentre study involved 88 women undergoing suburethral sling procedure for stress urinary incontinence (SUI). The retropubic route (RPR) and the transobturator route (TOR) were used in 42 and 46 women, respectively. No difference in epidemiologic and preoperative urinary functional status (SUI stage, and pollakiuria, nocturia, and urgency rates) was found between the groups. Functional results and quality of life were evaluated before surgery and at 1, 3, 6, and 12 mo postoperatively. Urodynamic examinations were performed before and 3 mo after surgery.
                The mean follow-up was 10 mo. No difference in the rate of de novo urge incontinence and immediate and late voiding dysfunction was noted between the groups. No difference in the cure rate was observed between the groups (89.3% in the RPR group and 88.6% in the TOR group). RPR was associated with a significant decrease in maximum urinary flow and an increase in residual urine volume. Quality of life was significantly improved after surgery without difference between the groups.
                Retropubic and transobturator routes for treatment of female SUI have similar high cure rates and quality of life improvement. Because of advantages in the rate of complications and postoperative pain previously demonstrated on the same population, the transobturator route appears to be the best option for the treatment of urinary incontinence. To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence.
                Following ethics approval, 195 (3 x 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. MAIN OUTCOME MEASURES WERE: (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings.
                There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11).
                All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out. To assess the effectiveness and late postoperative morbidity of the Burch procedure and the sling procedure for the treatment of recurrent urinary stress incontinence after vaginal hysterectomy and anterior repair.
                Clinical, urodynamic, and sonographic examinations were done on 77 women suffering with recurrent urinary stress incontinence. The women were randomized to two groups, modified Burch colposuspension and lyophilized dura mater sling surgery; 72 women were reexamined 32-48 months after these procedures.
                The cure rate at 32-48 months' follow-up was 86% for the Burch procedure and 92% for the sling. Women who had had the sling procedure demonstrated a clear decrease in maximal bladder capacity, from 330 to 240 mL (P < .05). In both groups, stress profiles demonstrated a shift of maximal pressure point toward the proximal urethra and a significant improvement in pressure transmission (P < .05). The post-operative patients who had persistent incontinence were found to have insufficient elevation of the bladder neck (less than 10 mm). The uroflow examination showed an increase of urination time in both groups. The incidence of bladder problems was 10% with the Burch procedure and 29% with the sling procedure; however, 13% of the Burch group developed rectoceles.
                Both procedures offer a high rate of success. We believe that the sling surgery should be used only in certain special cases because of its higher rate of complications, but that posterior vaginal repair should be considered after modified Burch colposuspension because of the possibility of rectocele and enterocele. We compared morbidity and success rate of pubovaginal sling with Burch colposuspension operations in Type I/type II genuine stress urinary incontinence (GSI). The study included patients who had no preoperative detrusor instability (DI), no recurrent GSI, no severe pelvic prolapsus and whose Valsalva leak point pressure (VLPP) values were higher than 90 cm water. Twenty three of free-rectus fascial sling and 23 of Burch colposuspension operations were performed randomly on the patients by a single surgeon. There was no statistical difference between patients in terms of age, BMI, parity, number of daily pads used and preoperative bladder neck mobility. Operation time, change in hematocrit, spontaneous voiding time, length of hospitalization and urinary infection were not different in 2 procedures. 17 patients from both groups could be compared after one year. The bladder neck mobility of both groups were similar. One surgical failure, 1 DI, 1 severe cystocele and 1 enterocele were found in the Burch group while only 1 DI was found in the pubovaginal sling group. When pubovaginal sling operation was performed as the primary surgery on the patients with type I/II GSI, the morbidity, complications and 1 year success rate are the same as Burch procedure. This study aims to analyze comparatively the efficacy and safety of synthetic transobturatory and aponeurotic retropubic slings, in the treatment of stress urinary incontinence (SUI) in women.
                Patients were separated in a randomized way. Twenty-one patients were submitted to the operatory correction by the transobturatory sling technique, whereas 20 patients were operated by the retropubic sling technique. All patients were submitted to complete physical exam and urodynamic test. The "T" test and the Mann-Whitney U test were applied to establish comparisons between the two groups. Patients were followed-up for 12 months.
                Healing rate was 90.5% (19/21) and 95% (19/20), respectively after 12 months. The transobturatory group presented lesser complications rate than the retropubic group.
                The transobturatory and the aponeurotic slings techniques were equally effective for the treatment of SUI. The transobturatory sling has shown fewer complications and lesser surgical time than the aponeurotic sling technique. To compare the cure rate and confirm the clinical efficacy of the 3 most frequently performed surgical procedures for stress urinary incontinence (SUI).
                Between January 2001 and May 2003, 92 women with SUI were randomly assigned to undergo the Burch colposuspension (n=33), pubovaginal sling (n=28), or tension-free vaginal tape (n=31) at the Department of Obstetrics and Gynecology, Yonsei Medical Center, Seoul, Korea. Patient characteristics, urodynamic study results, cure rates at 3, 6, and 12 months, and complication rates were compared using the chi2 test.
                There were no statistically significant differences in the cure rates initially, but after 12 months the cure rate of the pubovaginal sling procedure was found to be significantly higher than those of the tension-free vaginal tape or Burch colposuspension procedures.
                The cure rate of the pubovaginal sling procedure was significantly higher after 1 year, but no difference in efficacy was observed between the 2 other procedures. A randomized prospective study of a larger population should be conducted. The aim of this study was to compare a modified Burch procedure with a suburethral sling for the treatment of stress incontinence complicated by a low-pressure urethra.
                Thirty-six women with stress incontinence, low-pressure urethra, and urethral hypermobility (straining cotton swab angle >/=30 degrees ) were randomly assigned to undergo either a modified Burch procedure (n = 19) or a suburethral sling (n = 17). Objective and subjective cure rates at 3 months after the operation were the primary outcome measures. Comparisons of group means were performed with the Student t test for independent groups, and proportions were compared with the Fisher exact test.
                After the operation the 2 groups had statistically similar cure rates and voiding function. Urethral closure pressure, pressure transmission ratios, and maximum detrusor pressure during voiding were significantly higher in the sling group.
                At 3 months there were no clinically significant differences between the groups treated with suburethral sling and modified Burch procedures. The purpose of this study was to compare the surgical outcome and attendant complications of the suprapubic arc (SPARC) sling and tension-free vaginal tape (TVT) procedures. Sixty-two women with genuine stress incontinence (GSI) alone or combined with pelvic prolapse less than International Continence Society (ICS) stage II were randomly allocated to either SPARC or TVT groups. A routine suprapubic ultrasonography was performed for all patients 1 day after the anti-incontinence operation. A comparison of the peri- and postoperative results comprising surgical outcomes and complications revealed no significant differences between the two groups. Although the difference in the rates of bladder injury was not statistically significant (SPARC 12.9 vs TVT 0.0%, p = 0.112), it was clinically significant. Routine suprapubic ultrasonography revealed eight subjects had retropubic hematomas greater than 5 cm. The cure rate for SPARC was not significantly different from TVT (80.7 vs 87.1%, p = 0.706). We concluded that the SPARC sling and TVT procedures proved to be equally effective. Subsequent suprapubic ultrasonography, in particular for the symptomatic patients, was found to be of clinical merit.
Traditional slings seem to be as effective as minimally invasive slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long term adverse event profile is still unclear. Reliable evidence to clarify whether or not traditional suburethral slings may be better or worse than other surgical or conservative management options is lacking.