PURPOSE: To assess the efficacy and safety of tension-free vaginal tape (TVT)-Secur for stress urinary incontinence (SUI). METHODS: A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register. RESULTS: Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O) and TVT. We found that TVT-Secur had significant reductions in operative time, visual analog score for pain, and postoperative complications compared with TVT-O. Even though TVT-Secur had a significantly lower subjective cure rate (P<0.00001), lower objective cure rate (P<0.00001), and higher intraoperative complication rate, compared with TVT-O at 1 to 3 years, there was no significant difference between TVT-Secur and TVT-O in the subjective cure rate (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.22-1.08; P=0.08), objective cure rate (OR, 0.49; 95% CI, 0.22-1.09; P=0.08), or complications at 3 to 5 years. Moreover, TVT-Secur had significantly lower subjective and objective cure rates compared with TVT. CONCLUSIONS: This meta-analysis indicates that TVT-Secur did not show an inferior efficacy and safety compared with TVT-O for SUI in 3 to 5 years, even though displaying a clear tread toward a lower efficacy in 1 to 3 years. Considering that the safety is similar, there are no advantages in using TVT-Secur.
Female* ; Humans ; Intraoperative Complications ; Operative Time ; Postoperative Complications ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Stress

PUROPOSE: Transobturator sling is a new minimally invasive treatment for female stress urinary incontinence. We compared the efficacy and safety of the two procedures, Monarc and TVT-O. MATERIAL AND METHODS: We included 110 patients with stress urinary incontinence who underwent the Monarc (n=52) or TVT-O (n=58) procedure and followed up at least for 1 year. Preoperative evaluations, the indices of voiding and postoperative complication were investigated. They were analyzed by Student's t-test, Paired t-test and chi-square test. RESULTS: There were no significant difference in the preoperative patients' characteristics, postoperative complication and success rate between the two groups. The preoperative and postoperative storage symptoms between two groups had no significant difference but the patients of both groups had significant improvement in storage symptoms such as frequency and urgency after surgery. CONCLUSIONS: The Monarc and TVT-O is equally effective and safe procedures as a treatment method of female stress urinary incontinence.
Female ; Humans ; Postoperative Complications ; Suburethral Slings ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Stress

Most of anti-incontinence surgeries bear the risk of postoperative complication such as voiding dysfunction due to urethral obstruction. Fortunately, Tension Free Vaginal Tape(TVT) procedure has much lower incidence of postoperative urethral obstruction than other surgical procedures for stress urinary incontinence. There are many reports about the surgical treatments for short-term urethral obstruction after TVT procedure. However, there are few reports on the effect of surgical releasing of the obstruction lasting for a long period. In our case, the patient had urethral obstruction for 32 months after TVT procedure and she was able to void well after surgical releasing of the tape. We suggest that releasing of the tape will be a treatment of choice for long-term urethral obstruction after TVT procedure.
Humans ; Incidence ; Postoperative Complications ; Suburethral Slings* ; Urethral Obstruction* ; Urinary Incontinence

Various postoperative complications have been reported after the use of tension-free vaginal tapes (TVT). The transobturator approach was introduced to minimize the potential complications. The next generation of recently introduced TVT-SECUR is intended to minimize the incidence of complications. Herein we report a case of internal pudendal artery injury sustained during this procedure that was successfully treated by radiological embolization. Angiography with vessel embolization, when available, should be considered when the arterial injury is suspected.
Angiography ; Arteries ; Glycosaminoglycans ; Incidence ; Postoperative Complications ; Suburethral Slings ; Urinary Incontinence

The relevant documents of apoplectic urinary incontinence treated with acupuncture-moxibustion in recent 5 years have been collated and analyzed in aspect of current situation of acupuncture-moxibustion treatment, acupoint selection, manipulation and problems. The result indicates that the main therapy for this disease is acupuncture-moxibustion combined with electroacupuncture or other methods, and the acupuncture-moxibustion therapy is superior to the medicine. The clinical research has made considerable progress and the great importance has been attached to the research method. The main problems are low credibility of total quality, inconsistent curative course, incomplete case of illness, missing of quality control, disordered standards of clinical diagnosis and curative effect evaluation, varied observation index and phatic discussion of mechanism. It is suggested to carry on scientific research, enhance research lever, expand mind, innovate ideas, and establish uniformed standards of diagnosis and curative effect evaluation and observation index.
Acupuncture Therapy ; Humans ; Moxibustion ; Stroke ; complications ; Urinary Incontinence ; etiology ; therapy

This study was undertaken to compare the complications of outside-in transobturator tape procedures (TOT) and inside-out transobturator tape procedures (TVT-O) with concomitant gynecologic surgery for the treatment of female stress urinary incontinence (SUI). A retrospective review of 206 consecutive patients who underwent either TOT or TVT-O with concomitant gynecologic operations between March 2008 and February 2011 was conducted. The incidence of perioperative complications was compared. For statistical analysis, chi-squared tests were used. There were no reports of intraoperative complications such as vaginal injury or bladder perforation. Postoperative complications were noted in 23 procedures (11.2%). These included 6 cases of urinary retention (2.9%), 2 cases of vulva hematoma (1.0%), 7 cases of urinary tract infection (3.4%), 4 cases of de novo urgency (2.9%), and 4 cases of vaginal erosion (2.9%). There were no significant differences in complication rates between the two groups. Our results suggest that inside-out and outside-in procedures are simple and safe techniques that may have a low rate of complications when used with a concomitant gynecologic operation.
Female ; Gynecologic Surgical Procedures ; Hematoma ; Humans ; Incidence ; Intraoperative Complications ; Postoperative Complications ; Retrospective Studies ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urinary Retention ; Urinary Tract Infections ; Vulva

PURPOSE: To analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS: Two hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n=127 adjustable male sling [n=95 Argus classic, n=32 Argus T], n=155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P<0.05). RESULTS: We found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P=0.003). The most frequent intraoperative complication was bladder perforation (n=17). Postoperative infection rates did not vary significantly between the respective devices (P=0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P=0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556; P=0.001). CONCLUSIONS: Complication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival.
Cohort Studies ; Humans ; Intraoperative Complications ; Logistic Models ; Male* ; Multivariate Analysis ; Postoperative Complications ; Suburethral Slings* ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Sphincter, Artificial*

PURPOSE: The purpose of our study was to investigate the safety and efficacy of the suprapubic arch (SPARC) sling operation and the transobturator tape (MONARC) sling operation according to body mass index (BMI). MATERIALS AND METHODS: Between January 1, 2004, and July 12, 2009, a retrospective clinical trial was performed with 284 patients treated by the SPARC sling procedure and 49 patients treated by the MONARC sling procedure. The women were classified into 3 groups by BMI according to the WHO Expert Consultation: normal weight (A, BMI 18.5 to 22.9 kg/m2), overweight (B, BMI 23 to 27.5 kg/m2), and obese (C, BMI>27.6 kg/m2). Patients' characteristics and clinical outcomes of the operation were analyzed according to BMI at 1 year after surgery via questionnaires and interviews with the patients about their voiding symptoms and medical records. RESULTS: There were 103 patients in group A, 186 in group B, and 34 in group C. The objective cure rates for groups A, B, and C after the SPARC procedure were 94.4%, 96.7%, and 96.8%, respectively (p=0.321), and the subjective cure rates were 94.4%, 96.1%, and 96.8%, respectively (p=0.222). The objective cure rates for groups A, B, and C after the MONARC procedure were 100.0%, 90.9%, and 66.7%, respectively (p=0.742), and the subjective cure rates were 92.3%, 93.9%, and 66.7%, respectively (p=0.779). The complication rates were similar among the three study groups. CONCLUSIONS: Mid-urethral sling procedures for urinary incontinence result in similar objective and subjective cure rates and postoperative complications irrespective of BMI.
Body Mass Index ; Female ; Humans ; Obesity ; Overweight ; Postoperative Complications ; Retrospective Studies ; Suburethral Slings ; Urinary Incontinence ; Urinary Incontinence, Stress

PURPOSE: Midurethral synthetic slings for female stress urinary incontinence are minimally invasive polypropylene mesh tapes that are inserted under the midurethra with trocars. In the past decade, this new technology has become the most commonly performed procedure for female stress urinary incontinence, replacing the traditional open procedures. However, its effectiveness in pre- and postmenopausal women has not previously been compared. MATERIALS AND METHODS: We assessed the clinical outcome of the transobturator tape (TOT) procedure in premenopausal (n=45) and postmenopausal (n=49) women by means of self-report and the Urinary Distress Inventory 6 (UDI-6) questionnaire. RESULTS: The mean age of the pre- and postmenopausal women was 44 and 60 years, respectively. Mean parity was 2.4 and 3, respectively. There were no significant differences with respect to mean operation time, duration of hospitalization, or intraoperative and postoperative complications. However, premenopausal women were more satisfied with the operation than were postmenopausal women (p=0.014). Also, UDI-6 scores were significantly better in premenopausal women (p=0.027). CONCLUSIONS: The TOT operation appeared to be more effective in premenopausal women with stress urinary incontinence. However, further studies with larger sample sizes are needed to confirm our results.
Female ; Hospitalization ; Humans ; Parity ; Polypropylenes ; Postmenopause ; Postoperative Complications ; Premenopause ; Sample Size ; Suburethral Slings ; Surgical Instruments ; Urinary Incontinence ; Urinary Incontinence, Stress

PURPOSE: To evaluate the results of colpopexy using a modified tension- free vaginal tape(TVT) device and simultaneous TVT in patients with marked cystocele, with or without stress urinary incontinence. MATERIALS AND METHODS: A total of 34 patients who underwent a colpopexy and TVT procedure for marked cystocele, with or without stress urinary incontinence, were included. Initially, colpopexy, using a modified TVT device, was completed followed by the TVT procedure. A modified TVT needle, which had two pinholes at the end of the needle, for the suture materials to be threaded through, was used for transfer of thread to the ipsilateral suprapubic incision through the retropubic space. Each side of the ligature was tied together in the subcutaneous space, thereafter the TVT procedure was completed in the usual manner. RESULTS: A total of 34 patients were available to follow-up for more than 6 months. The mean operation time and postoperative hospital stay were 57.5+/-15.3 minutes and 3.5+/-1.7 days, respectively. The cystocele was completely corrected in 31 patients(91.2%), and diminished to grade I in 3. Also, 25 of the 26 patients who had stress urinary incontinence were successful with the combined operation. There were no significant intraoperative or postoperative complications. CONCLUSIONS: Our data suggest that the simultaneous cystocele repair using a modified TVT device and TVT procedure is effective in patients with marked cystocele, with or without stress urinary incontinence. Furthermore, it seems to be a very simple procedure, with low morbidity.
Cystocele* ; Follow-Up Studies ; Humans ; Length of Stay ; Ligation ; Needles ; Postoperative Complications ; Sutures ; Urinary Incontinence ; Urinary Incontinence, Stress