Caramazza Daniela 1, Pizzacalla Sara 1, Campagna Giuseppe 1, Panico Giovanni 1, Marturano Monia 1, Trivellizzi Ilaria Nausica 1, Scambia Giovanni 1, Cervigni Mauro , Ercoli Alfredo 2
1) Fondazione Policlinico Universitario “A. Gemelli - IRCCS
2) Università degli Studi di Messina
INTRODUCTION AND AIM OF THE STUDY.
Urinary incontinence is a widespread disturb afflicting from 6 to 69% of women, according to data available, with a median prevalence of 45-50%. Aim of our study was providing a clinical and ultrasound follow-up in patient undergoing surgery for SUI with two different techniques. Progress in surgical approach to Stress Urinary incontinence is leading to the development of less invasive techniques, with same efficacy and feasibility and with lower rate of post-operative complications. On this background, we compared clinical and ultrasound outcomes after the use of Transobturatory Tape (TOT) vs Single Incision Mid-urethral sling. As a matter of fact literature provides few or no data regarding ultrasound characteristics in patients after SUI surgery, even though this aspect could represent a further element of comparison in these patients thanks to new techniques as the use of 3D scan.
MATERIALS AND METHODS.
We retrospectively analysed data regarding 30 patients with stress urinary incontinence treated with a surgical approach using TOT (15 patients) or Single Incision mid urethral sling from January 2017 to January 2018. The assessment of the SUI incontinence was made by an Urogynecologist using anamnestic and clinical (Q-tip and stress test) examination and administrating the ICI-Q-SF test. The preoperative workup in these patients was comprehensive of a urodynamic examination, an ultrasound scan of kidneys, ureters and bladder, a transvaginal US and a pap test. Patient with neurological diseases, mixed urinary incontinence, previous SUI surgery and POP-Q >2° degree prolapse were not included. Three expert uroginecologist, helped by residents, used a Transobturatory approach (810081-GYNECARE TVT OBTURATOR TENSION FREE SUPPORT FOR INCONTINENCE) versus a single incision mid urethral sling or mini-sling (ALTIS® COLOPLAST) according to NICE 2015 Guidelines and surgeon’s choice based on personal experience. The follow up was based on clinical examination (stress test, Q-tip test), PGI-I index, and ICI-Q-SF test to evaluate the improving in symptoms, quality of life and/or SUI recurrence after one month, three months up to one year post operatively (for patients operated in January 2017). We performed a ultrasound examination at the three months FUP (2D, 3D with sagittal and axial examination of volumes using an US probe, BK medical, flex focus).
Intraoperative data are shown in table 1. At the post-operative FUP all patients presented a regular vaginal profile. All patients showed an improving in symptoms. None of the patients presented post voidal residual or voiding dysfunction in both groups. Only one patient in TOT group showed residual SUI (at high bladder volume i.e. 400 cc) but still referring an improvement in ICI-Q-F questionnaire. Both groups showed a significant improvement in ICI-Q–SF questionnaire, with no significant differences in the two groups. The US examination at three months considered the following parameters: distance sling-internal urethra sphincter, distance sling- lumen of urethra, presence of curling/twisting, distance sling- symphysis of pubic bone, angle formed by the sling branches. The mean result was the difference in the angle between the sling branches in the two groups: median value of 115° in the minisling group, median value of 146° in the TOT group; (Fig. 1 and 2). In both groups a urge onset (often associated to UUI) was observed, with sligthly higher prevalence in the minisling group, even if no significant differences were found (p value >0.05). these data are shown in table 2. All patients showed improvement in personal satisfaction: 100 % of mini-sling patient had PGI-I of 3 (range 1-3) and 60% of TOT had a PGI-I 3, 40 % had a PGI I of 2.
The aim of the present study was to compare two surgical techniques TOT vs Mini-sling with the help of 2D and 3D US scan. Statistical analysis was performed using SPSS program 13.0 for Windows. This was an important tool to help finding correlations between anatomy, the real in vivo morphology of the sling and clinical-functional outcomes. As a matter of fact, we can by now consider TOT and mini-sling as two valuable techniques to treat SUI and our small study can allow us to assess coarse differences between the two groups that need to be further investigated.
1- Samer Shamout, MD and Lysanne Campeau, MDCM Stress urinary incontinence in women: Current and emerging therapeutic options Samer Shamout, MD and Lysanne Campeau, MDCM Can Urol Assoc J. 2017 Jun; 11(6Suppl2): S155–S158
2- Bernard T. Haylen et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction, Neurourology and Urodynamics 29:4–20 (2010)
3- Mid-urethral sling operations for stress urinary incontinence in women (Review). Cochrane Library, Cochrane Database Systematic Review, 2015.