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Surgeons’ views on sling tensioning during surgery for female stress urinary incontinence

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An Erratum to this article was published on 12 May 2017

This article has been updated

Abstract

Introduction and hypothesis

Little is known regarding the use of various techniques for sling tensioning. Our objective was to determine which techniques are most commonly used by surgeons and surgeons’ views on sling tensioning.

Methods

An Internet-based survey designed to assess the use of various tensioning evaluation methods, different sling tensioning techniques, and views and beliefs regarding the importance of tensioning was sent to members of major sub-specialty professional organizations. The responses were analyzed using descriptive statistics, and univariate and multivariate logistic analyses were performed to assess the effect of various surgeon characteristics on operative techniques.

Results

A total of 596 surgeons (63% gynecologists, 37% urologists) from 56 different countries were included in the analysis. Over 30% of respondents reported performing >50 sling operations/year. Use of objective intraoperative tension evaluation methods was 15.6, 7.8, and 1.9% for intraoperative stress tests, cystoscopic evaluation of urethral coaptation, or Q-tip tests respectively. Sixty-three percent indicated that they tension retropubic transvaginal tape (RP) and transobturator tape (TOT) slings similarly, whereas 26.2% place more tension on TOT than RP slings and 10.4% place more tension on RP than TOT slings. Those with fellowship training were 66% more likely to utilize leak point pressure results to inform the degree of tensioning (OR 1.66, CI 1.04–2.66).

Conclusions

Our results indicate that there is a wide degree of variation in technique among surgeons. Prospective studies assessing the utility of various techniques could provide more evidence-based approaches to midurethral sling surgery and potentially improve quality and patient outcomes.

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Change history

  • 12 May 2017

    An erratum to this article has been published.

References

  1. Rovner ES, Wein AJ. Treatment options for stress urinary incontinence. Rev Urol. 2004;6 Suppl 3:S29–47.

    PubMed  PubMed Central  Google Scholar 

  2. Ulmsten U, Petros P. Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol. 1995;29(1):75–82.

    Article  CAS  PubMed  Google Scholar 

  3. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(2):81–5. discussion 85–6.

  4. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11(6):1306–13.

    CAS  PubMed  Google Scholar 

  5. Jonsson Funk M, Levin PJ, Wu JM. Trends in the surgical management of stress urinary incontinence. Obstet Gynecol. 2012;119(4):845–51.

    Article  PubMed  Google Scholar 

  6. Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse [press release]. Center for Devices and Radiological Health, U.S. Food & Drug Administration; 2011.

  7. Position Statement on Mesh Midurethral Slings for Stress Urinary Incontinence. American Urogynecologic Society (AUGS) and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU); 2014.

  8. Ford AA, Rogerson L, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2015;7:CD006375.

    Google Scholar 

  9. Levin I, Groutz A, Gold R, Pauzner D, Lessing JB, Gordon D. Surgical complications and medium-term outcome results of tension-free vaginal tape: a prospective study of 313 consecutive patients. Neurourol Urodyn. 2004;23(1):7–9.

    Article  PubMed  Google Scholar 

  10. Novara G, Galfano A, Boscolo-Berto R, Secco S, Cavalleri S, Ficarra V, et al. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol. 2008;53(2):288–308.

    Article  PubMed  Google Scholar 

  11. Klutke C, Siegel S, Carlin B, Paszkiewicz E, Kirkemo A, Klutke J. Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology. 2001;58(5):697–701.

    Article  CAS  PubMed  Google Scholar 

  12. Duckett JR, Jain S. Groin pain after a tension-free vaginal tape or similar suburethral sling: management strategies. BJU Int. 2005;95(1):95–7.

    Article  PubMed  Google Scholar 

  13. Norton PA, Nager CW, Chai TC, Mueller E, Stoddard A, Lowder J, et al. Risk factors for incomplete bladder emptying after midurethral sling. Urology. 2013;82(5):1038–41.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ulmsten U, Falconer C, Johnson P, Jomaa M, Lanner L, Nilsson CG, et al. A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(4):210–3.

    Article  CAS  PubMed  Google Scholar 

  15. Comiter CV. Surgery insight: management of failed sling surgery for female stress urinary incontinence. Nat Clin Pract Urol. 2006;3(12):666–74.

    Article  PubMed  Google Scholar 

  16. Kobashi KC, Govier FE. Management of vaginal erosion of polypropylene mesh slings. J Urol. 2003;169(6):2242–3.

    Article  CAS  PubMed  Google Scholar 

  17. Bodelsson G, Henriksson L, Osser S, Stjernquist M. Short term complications of the tension free vaginal tape operation for stress urinary incontinence in women. BJOG. 2002;109(5):566–9.

    Article  PubMed  Google Scholar 

  18. Mukai M, Aboujaoude R, Culligan PJ. Two cases illustrating a potential difference between transobturator and retropubic slings. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(8):967–9.

    Article  PubMed  Google Scholar 

  19. Dietz HP, Barry C, Lim Y, Rane A. TVT vs Monarc: a comparative study. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):566–9.

    Article  PubMed  Google Scholar 

  20. Rapp DE, Govier FE, Kobashi KC. Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of Sparc and Monarc slings. Int Braz J Urol. 2009;35(1):68–75. discussion.

    Article  PubMed  Google Scholar 

  21. Whiteside JL, Walters MD. Anatomy of the obturator region: relations to a trans-obturator sling. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(4):223–6.

    PubMed  Google Scholar 

  22. Nager CW, Brubaker L, Litman HJ, Zyczynski HM, Varner RE, Amundsen C, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med. 2012;366(21):1987–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Lose G, Klarskov N. Utility of invasive urodynamics before surgery for stress urinary incontinence. Int Urogynecol J. 2014;25(1):1–3.

  24. Lose G, Klarskov N. Utility of invasive urodynamics before surgery for stress urinary incontinence: response to correspondence. Int Urogynecol J. 2014;25(7):1001.

    Article  PubMed  Google Scholar 

  25. Lose G, Klarskov N. Re: does preoperative urodynamics improve outcomes for women undergoing surgery for stress urinary incontinence? A systematic review and meta-analysis. BJOG. 2015;122(8):1147–8.

    Article  PubMed  Google Scholar 

  26. Agarwal A, Rathi S, Patnaik P, Shaw D, Jain M, Trivedi S, et al. Does preoperative urodynamic testing improve surgical outcomes in patients undergoing the transobturator tape procedure for stress urinary incontinence? A prospective randomized trial. Korean J Urol. 2014;55(12):821–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Serati M, Ghezzi F, Cattoni E, Braga A, Siesto G, Torella M, et al. Tension-free vaginal tape for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 10-year follow-up. Eur Urol. 2012;61(5):939–46.

    Article  PubMed  Google Scholar 

  28. Kawasaki A, Wu JM, Amundsen CL, Weidner AC, Judd JP, Balk EM, et al. Do urodynamic parameters predict persistent postoperative stress incontinence after midurethral sling? A systematic review. Int Urogynecol J. 2012;23(7):813–22.

    Article  PubMed  Google Scholar 

  29. Kawashima H, Hirai K, Okada N, Takahara Y, Kurisu T, Sumi T, et al. The importance of studying pressure-flow for predicting postoperative voiding difficulties in women with stress urinary incontinence: a preliminary study that correlates low Pdet x Qave with postoperative residual urine. Urol Res. 2004;32(2):84–8.

    Article  PubMed  Google Scholar 

  30. Hong B, Park S, Kim HS, Choo MS. Factors predictive of urinary retention after a tension-free vaginal tape procedure for female stress urinary incontinence. J Urol. 2003;170(3):852–6.

  31. Daneshgari F, Kong W, Swartz M. Complications of mid urethral slings: important outcomes for future clinical trials. J Urol. 2008;180(5):1890–7.

    Article  PubMed  Google Scholar 

  32. Nitti VW, Carlson KV, Blaivas JG, Dmochowski RR. Early results of pubovaginal sling lysis by midline sling incision. Urology. 2002;59(1):47–51. discussion 52.

    Article  PubMed  Google Scholar 

  33. Dmochowski RR, Padmanabhan P, Scarpero HM. Slings: autologous, biologic, synthetic, and midurethral. In: Wein AJ, editor. Campbell-Walsh urology. 10th ed. Philadelphia: Elsevier; 2012. p. 2115–67.

    Chapter  Google Scholar 

  34. Velemir L, Amblard J, Jacquetin B, Fatton B. Urethral erosion after suburethral synthetic slings: risk factors, diagnosis, and functional outcome after surgical management. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(7):999–1006.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue (ND20), Cleveland, OH, 44195, USA

    Ali Borazjani

  2. Glickman Kidney and Urologic Institute, Cleveland Clinic, Cleveland, 44195, OH, USA

    Javier Pizarro-Berdichevsky & Howard B. Goldman

  3. Urogynecology Unit, H. Dr. Sotero del Rio, Santiago, Chile

    Javier Pizarro-Berdichevsky

  4. Division Obstetricia y Ginecologia, Pontificia Universidad Católica de Chile, Santiago, Chile

    Javier Pizarro-Berdichevsky

  5. Quantitative Health Sciences, Cleveland Clinic, Cleveland, 44195, OH, USA

    Jianbo Li

Authors
  1. Ali Borazjani
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  2. Javier Pizarro-Berdichevsky
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  3. Jianbo Li
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  4. Howard B. Goldman
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Corresponding author

Correspondence to Ali Borazjani.

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Conflicts of interest

A. Borazjani reports equity interest in Innometrix LLC, outside the submitted work; in addition, A. Borazjani has a patent, WO 2016025757 A1, pending. J. Pizarro-Berdichevsky, H.B. Goldman, and J. Li have nothing to disclose.

Additional information

The original version of this article was revised: Due to a publisher’s error, the original version of this article was published online with an incorrectly transposed Table 1.

An erratum to this article is available at https://doi.org/10.1007/s00192-017-3350-3.

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Borazjani, A., Pizarro-Berdichevsky, J., Li, J. et al. Surgeons’ views on sling tensioning during surgery for female stress urinary incontinence. Int Urogynecol J 28, 1489–1495 (2017). https://doi.org/10.1007/s00192-017-3298-3

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  • DOI: https://doi.org/10.1007/s00192-017-3298-3

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