Short-, medium- and long-term results of the sling operations effectiveness and safety for urinary incontinence in women

Introduction. Sling urethropexy is considered the «gold standard» surgical treatment for stress urinary incontinence in women. However, the long-term results of such operations have not yet been fully studied.
Purpose of the study. To evaluate the results of using various options for sling operations at different periods of postoperative follow-up.
Materials and methods. In 698 women aged 42 - 68 years (median — 54 years) suffering stress incontinence were used 4 variants of sling operations according to the database of the S.P. Botkin City Clinical Hospital: TVT retropubic technique; transobturator technique TVT-O («inside-out»); transobturator technique TOT («outside-in»); mini sling system. The period of postoperative follow-up was 6 - 139 months (median 79 months). Evaluation of treatment results was carried out according to the following periods of postoperative follow-up: short-term (up to 1 year inclusive); mediumterm (a period from 1 to 5 years inclusive); long-term (over 5 years). The success of the treatment was determined by the criterion of the absence of urine involuntary loss during the cough test and the 1-hour pad test.
Results. Treatment success in the entire sample of patients was 96.1% (671 / 698) for the short-term criterion, 93.1% (591 / 635) for the medium-term criterion and 86.2% for the long-term criterion (467 / 642). The effectiveness of short-term treatment after TVT was 97%, TVT-O — 95.8%, TOT — 96.2%, mini-sling system — 95.5%, in medium-term — 92.2%, 93.1%, 90.9% and 92.3%, respectively, for long-term — 87.1%, 86.2%, 85.2% and 85%, respectively. There were no significant differences between the indicated variants of sling operations in terms of treatment efficacy for all observation periods (p > 0.05). Intra and early postoperative complications were noted in 51 (7.3%) cases, late — in 79 (11.3%). There were no significant differences in the incidence of both categories of complications between the surgical techniques used (p > 0.05). Only surgical experience significantly affects the risk of recurrent urinary incontinence after surgery, early and late postoperative complications.
Conclusions. The success of surgical treatment for stress urinary incontinence in women does not significantly depend on the type of sling surgery but depends mainly on the surgical experience. Therefore, it is advisable to use sling operations in hospitals with extensive experience in this area.

1. Almousa S, Bandin van Loon A. The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: A systematic review. Maturitas. 2018;107:78-83. DOI: 10.1016/j.maturitas.2017.10.003

2. Mostafaei H, Sadeghi-Bazargani H, Hajebrahimi S, Salehi-Pourmehr H, Ghojazadeh M, Onur R, Al Mousa RT, Oelke M. Prevalence of female urinary incontinence in the developing world: A systematic review and meta-analysis-A Report from the Developing World Committee of the International Continence Society and Iranian Research Center for Evidence Based Medicine. Neurourol Urodyn. 2020;39(4):1063-1086. DOI: 10.1002/nau.24342.

3. Itkonen Freitas AM, Rahkola-Soisalo P, Mikkola TS, Mentula M. Current treatments for female primary stress urinary incontinence. Climacteric. 2019;22(3):263-269. DOI: 10.1080/13697137.2019.1568404

4. Shkarupa D.D., Kubin N.D. Low-invasive surgery of the stress urinary incontinence at women: 5-years experience of use of the prosthesis. Vestnik Sankt-Peterburgskogo universiteta. Serija 11. Medicina. 2014;(1):186-192. (In Russ.). eLIBRARY ID: 21466956

5. Hogewoning CR, Gietelink L, Pelger RC, Hogewoning CJ, Bekker MD, Elzevier HW. The introduction of mid-urethral slings: an evaluation of literature [published correction appears in Int Urogynecol J. 2015 Sep;26(9):1403-4]. Int Urogynecol J. 2015;26(2):229-234. DOI: 10.1007/s00192-014-2488-5

6. Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7(7):CD006375. DOI: 10.1002/14651858.CD006375.pub4

7. Tommaselli GA, Di Carlo C, Formisano C, Fabozzi A, Nappi C. Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis. Int Urogynecol J. 2015;26(9):1253-1268. DOI: 10.1007/s00192-015-2645-5

8. Burkhard FC (Chair), Bosch JLHR, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubaro A. EAU Guidelines on Urinary Incontinence in Adults. 2020. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urinary-Incontinence-2020.pdf Accessed September 15, 2020.

9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. DOI: 10.1097/01.sla.0000133083.54934.ae

10. Kasian G.R., Gvozdev M.Iu., Godunov B.N., Prokopovich M.A., Pushkar' D.Iu. Analysis of the results of urinary incontinence treatment in women using free suburethral synthetic sling: the experience of 1000 operations. Urologiia. 2013;(4):5-11. (In Russ.). eLIBRARY ID: 20589094

11. Istoksky K.N., Bazhenov I.V., Bazhenov A.A., Kogan O.S., Romanenko D.V. Implantation surgery for the treatment of urinary incontinence. Analysis of the immediate and long-term complications. Ural'skij medicinskij zhurnal. 2017;(2):82-86. (In Russ.). eLIBRARY ID: 28401707

12. Kravtsova N.A., Melkoniants T.G., Gvozdev M.Y., Krutova V.A. Surgical treatment of stress urinary incontinence. Urologiia. 2016;(4):35-41. (In Russ.). eLIBRARY ID: 27390768

13. Sun X, Yang Q, Sun F, Shi Q. Comparison between the retropubic and transobturator approaches in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. Int Braz J Urol. 2015;41(2):220-229. DOI: 10.1590/S1677-5538. IBJU.2015.02.06

14. Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, Kraus SR, Chai TC, Lemack GE, Dandreo KJ, Varner RE, Menefee S, Ghetti C, Brubaker L, Nygaard I, Khandwala S, Rozanski TA, Johnson H, Schaffer J, Stoddard AM, Holley RL, Nager CW, Moalli P, Mueller E, Arisco AM, Corton M, Tennstedt S, Chang TD, Gormley EA, Litman HJ; Urinary Incontinence Treatment Network. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066-76. DOI: 10.1056/NEJMoa0912658

15. Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C. Seventeen years' follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J. 2013;24(8):1265-1269. DOI: 10.1007/s00192-013-2090-2

16. Mostafa A, Lim CP, Hopper L, Madhuvrata P, Abdel-Fattah M. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and metaanalysis of effectiveness and complications. Eur Urol. 2014;65(2):402-27. DOI: 10.1016/j.eururo.2013.08.032

17. Madhuvrata P, Riad M, Ammembal MK, Agur W, Abdel-Fattah M. Systematic review and meta-analysis of «inside-out» versus «outside-in» transobturator tapes in management of stress urinary incontinence in women. Eur J Obstet Gynecol Reprod Biol. 2012;162(1):1-10. DOI: 10.1016/j.ejogrb.2012.01.004

18. Zyczkowski M, Nowakowski K, Kuczmik W, Urbanek T, Kaletka Z, Bryniarski P, Muskala B, Paradysz A. Tension-free vaginal tape, transobturator tape, and own modification of transobturator tape in the treatment of female stress urinary incontinence: comparative analysis. Biomed Res Int. 2014;2014:347856. DOI: 10.1155/2014/347856

19. Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V, Hilton P, Nilsson CG, Waltregny D. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2010;58(2):218-38. DOI: 10.1016/j.eururo.2010.04.022

20. Kachmazov A.A., Romih V.V. Comparative study of the treatment results using mesh prosthesis in women with urinary incontinence. Jeksperimental'naja i klinicheskaja urologija. 2013;(2):122-127. (In Russ.). eLIBRARY ID: 19433157

21. Gvozdev M.Y., Pushkar D.Y. Sling procedures to treat urinary incontinence in the Russian Federation. Urologiia. 2017;(4):97-101. (In Russ.). DOI: 10.18565/urol.2017.4.97-101

22. Gvozdev M.Yu. Recurrent forms of urinary incontinence. Jeksperimental'naja i klinicheskaja urologija. 2014;(3):80-87. (In Russ.). eLIBRARY ID: 22593072

23. Gvozdev M.Yu., Popov A.A., Bezhenar' V.F., Komlichenko E.V., Kappusheva L.M., Chernyshev I.V., Kachmazov A.A., Salyukova Yu.R., Politova A.K., Levakov S.A., Nasyrova N.I., Seregin A.V., Evseev A.A., Bryunin D.V., Dobrovol'skaya T.B., Sosnin N.A., Tolstikov S.P., Goncharov D.V., Zaripov T.Sh., Tugushev M.T., Dubinin A.A., Medvedeva A.B., Mironov M.A., Kravcova N.A., Titova I.G., Koroleva E.G., Soluyanov M.Yu., Shumkov O.A., Erkovich A.A., Strel'chenko O.V., Shangurova N.V., Lauteshveger E.V., Girgeshnikov V.S., Shiphineev Yu.V., Cyrenov T.B., Sharifulin M.A., Klyuev M.V., Tkachev V.N., Tupikina N.V., Kasyan G.R., Godunov B.N., Pushkar' D.Yu., Grebenkin A.G. Tension-free-tape. Preliminary analysis of Russian experience 2002-2012. Jeksperimental'naja i klinicheskaja urologija. 2012;(4):29-37. (In Russ.). eLIBRARY ID: 18348717

24. Gvozdev M.Yu. Surgical treatment of urinary incontinence in women using synthetic materials [dissertation]. Moscow; 2015. (In Russ.). Available at: http://medical-diss.com/docreader/594207/a?#?page=1. Accessed September 15, 2020.