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The fate of synthetic mid-urethral slings in 2013: A turning point

INTRODUCTION: Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal o...

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Autores principales: Barboglio, Paholo G., Ann Gormley, E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442984/
https://www.ncbi.nlm.nih.gov/pubmed/26558068
http://dx.doi.org/10.1016/j.aju.2013.04.005
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author Barboglio, Paholo G.
Ann Gormley, E.
author_facet Barboglio, Paholo G.
Ann Gormley, E.
author_sort Barboglio, Paholo G.
collection PubMed
description INTRODUCTION: Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal of diminishing the rate of complications andspeeding the recovery phase. METHODS: For this review we searched Medline for relevant papers, with an emphasis on meta-analysis and randomised controlled trials (RCTs). Specially selected reports were identified to address both ’index patients’ (defined as those with genuine SUI and no previous anti-incontinence procedure or other genitourinary sign or symptom that might affect her SUI) and, briefly, non-index patients. Two authors independently reviewed papers for eligibility. RESULTS: Level 1 evidence from a Cochrane review and two meta-analyses indicated that subjective outcomes with the mid-urethral sling (MUS) were similar to those from colposuspension. However, the MUS was better than colposuspension when assessing objective outcomes (Level 1). MUS are equally effective as autologous pubovaginal slings (Level1). Two meta-analyses suggest that retropubic MUS (RMUS) might be better than transobturator MUS when assessing objective outcomes. Five more recent RCTs with longer term outcomes showed high success rates and only one reported a significant advantage for the RMUS in women with intrinsic sphincteric deficiency. One meta-analysis addressing the SIS showed inferior outcomes to the MUS (Level 1). New and improved SIS techniques have been used, but long-term outcomes are limited and results are still controversial when compared to the MUS. CONCLUSION: MUS are still the standard to treat the index patient as previously stated by the American and European Associations of Urology. Currently data are lacking to define which sling and what approach works best. Complications are significantly different between sling types and are dependent on technique.
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spelling pubmed-44429842015-11-10 The fate of synthetic mid-urethral slings in 2013: A turning point Barboglio, Paholo G. Ann Gormley, E. Arab J Urol Urodynamics/Female Urology Review INTRODUCTION: Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal of diminishing the rate of complications andspeeding the recovery phase. METHODS: For this review we searched Medline for relevant papers, with an emphasis on meta-analysis and randomised controlled trials (RCTs). Specially selected reports were identified to address both ’index patients’ (defined as those with genuine SUI and no previous anti-incontinence procedure or other genitourinary sign or symptom that might affect her SUI) and, briefly, non-index patients. Two authors independently reviewed papers for eligibility. RESULTS: Level 1 evidence from a Cochrane review and two meta-analyses indicated that subjective outcomes with the mid-urethral sling (MUS) were similar to those from colposuspension. However, the MUS was better than colposuspension when assessing objective outcomes (Level 1). MUS are equally effective as autologous pubovaginal slings (Level1). Two meta-analyses suggest that retropubic MUS (RMUS) might be better than transobturator MUS when assessing objective outcomes. Five more recent RCTs with longer term outcomes showed high success rates and only one reported a significant advantage for the RMUS in women with intrinsic sphincteric deficiency. One meta-analysis addressing the SIS showed inferior outcomes to the MUS (Level 1). New and improved SIS techniques have been used, but long-term outcomes are limited and results are still controversial when compared to the MUS. CONCLUSION: MUS are still the standard to treat the index patient as previously stated by the American and European Associations of Urology. Currently data are lacking to define which sling and what approach works best. Complications are significantly different between sling types and are dependent on technique. Elsevier 2013-06 2013-06-14 /pmc/articles/PMC4442984/ /pubmed/26558068 http://dx.doi.org/10.1016/j.aju.2013.04.005 Text en © 2013 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology. http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
spellingShingle Urodynamics/Female Urology Review
Barboglio, Paholo G.
Ann Gormley, E.
The fate of synthetic mid-urethral slings in 2013: A turning point
title The fate of synthetic mid-urethral slings in 2013: A turning point
title_full The fate of synthetic mid-urethral slings in 2013: A turning point
title_fullStr The fate of synthetic mid-urethral slings in 2013: A turning point
title_full_unstemmed The fate of synthetic mid-urethral slings in 2013: A turning point
title_short The fate of synthetic mid-urethral slings in 2013: A turning point
title_sort fate of synthetic mid-urethral slings in 2013: a turning point
topic Urodynamics/Female Urology Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442984/
https://www.ncbi.nlm.nih.gov/pubmed/26558068
http://dx.doi.org/10.1016/j.aju.2013.04.005
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