Laparoscopic colposuspension versus vaginal suburethral slingplasty: a randomised prospective trial. Comparative results of two techniques to treat stress urinary incontinence: synthetic transobturator and aponeurotic slings. Functional results after the suburethral sling procedure for urinary stress incontinence: a prospective randomized multicentre study comparing the retropubic and transobturator routes. A prospective randomized study comparing modified Burch retropubic urethropexy and suburethral sling for treatment of genuine stress incontinence with low-pressure urethra. Endoscopic retropubic colposuspension: "Retziusscopy" versus laparoscopy--a reasonable enlargement of the operative spectrum in the management of recurrent stress incontinence? Randomized comparison of the suprapubic arc sling procedure vs tension-free vaginal taping for stress incontinent women. Autologous fascial sling vs polypropylene tape at short-term followup: a prospective randomized study. Comparison of pubovaginal sling and burch colposuspension procedures in type I/II genuine stress incontinence. Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence.
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. 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 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. 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 technical feasibility of the laparoscopic and extraperitoneal approach to the Burch colposuspension for treatment of grade II and III (moderate to severe) stress incontinence was examined in a randomised prospective study. Irrespective of the endoscopic access, two suspension techniques, namely conventional suture and stapler fixation of alloplastic materials, were compared. A total of 20 patients entered this preliminary evaluation. Three complications occurred; a bladder perforation (during laparoscopic dissection of the space of Retzius), a postoperative detrusor instability and transient urinary retention. Both the endoscopic approaches and the suspension procedures employed proved feasible and safe, and presented the advantages of a "minimal access" procedure, with short hospitalisation and rapid recovery. Short-term follow-up (6-12 months) showed subjective and objective results comparable to those of the conventional abdominal Burch colposuspension. Detailed evaluation of the subgroups is not yet feasible, as the number of patients in this preliminary evaluation was too small and follow-up too short. Final evaluation of the entire study population and long-term follow-up will be necessary before these procedures can be generally offered as a therapeutic alternative. 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. The incidence of urinary incontinence in women of childbearing age is about 30%. Around half have stress incontinence. Many treatment modalities have been elucidated to treat stress incontinence, and among the most popular are rectus fascia sling and tension-free vaginal tape (TVT). The introduction of TVT to the urological armamentarium put a multiplicity of synthetic materials into use in the correction of stress urinary incontinence. A comparison of the impact of these 2 commonly used techniques is needed.
                A total of 53 female patients older than 21 years (mean age 45.09) were randomized, using closed envelopes, to undergo TVT or rectus fascia sling. Randomization was performed after patients received spinal anesthesia. One surgeon performed the 2 types of treatment. Associated grade 2 cystocele was simultaneously corrected. Patients with bladder or urethral pathology, as well as those with cystocele greater than grade 2, were excluded from analysis.
                All 53 patients completed 6 months of followup and all had stress urinary incontinence. There were 15 patients who underwent sling surgery and 17 who underwent TVT who had concomitant grade 1 or 2 cystocele. No statistically significant difference was found between the 2 groups at baseline. Cure was accomplished in 23 of 25 (92%) with sling and in 26 of 28 (92.9%) with TVT at first followup visit (1 week). There were 7 patients who needed at least 1 extra week of catheterization in the sling group and 3 in the TVT group. No significant difference was detected in terms of post-void residual urine, symptom score, and filling and voiding parameters. At 6 months 1 patient had de novo detrusor overactivity and 7 had wound pain. Compared to those with TVT, 2 cases of sling were considered treatment failures, none had de novo overactivity and 2 had wound pain. None of the patients had symptoms suggestive of urethral erosion.
                Rectus fascia sling and TVT seem to be equally effective regarding primary outcome measure (ie cure of stress incontinence). Symptom score related to incontinence surgery as well as simultaneous correction of cystocele are comparable in the 2 groups. Fascial sling is a longer treatment process yet it is more economical. Longer followup is vital before rigorous conclusions can be drawn. 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. 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 current evidence base suggests that minimally invasive synthetic suburethral sling operations are as effective as traditional suburethral slings, open retropubic colposuspension and laparoscopic colposuspension in the short term but with less postoperative complications. Objective cure rates are higher with retropubic tapes than with obturator tapes but retropubic tapes attract more complications. Most of the trials had short term follow up and the quality of the evidence was variable.