Single-Incision Slings for the Treatment of Stress Urinary Incontinence: Efficacy and Adverse Effects at 10-Year Follow-Up - Beyond the Abstract

Stress urinary incontinence (SUI) is a common condition affecting up to 50% of women in developed countries, with the risk of requiring surgery of about 4%.1,2 Surgical treatment is indicated when conservative management fails.3 Many types of surgery have been performed over the years. To date, mid-urethral slings are considered the first option because of high efficacy rates.4 Different synthetic sling procedures are available. Single-incision slings (SISs) were introduced in 2006 with the purpose to decrease the risk of complications including visceral injury, major bleeding, infection, and neurological pain.5,6 SISs showed cure rates comparable with standard tapes in the short-term, with efficacy unaffected by age, body mass index (BMI), obstetrical history, and proper bilateral anchoring on obturator membranes.5,7-9 Nevertheless, there is a lack of evidence about long-term outcomes.

There are only a few studies considering the long-term outcomes of SIS. Sun et al. compared 31 TVT-O patients versus 33 SISs (TVT-Secur) 10 years after implantation.10 Their results showed that transobturator tape is superior in objective cure and subjective satisfaction and tends to decline less over 10 years. However, TVT-Secur was criticized for poor performance compared with other SISs, even in the short-term, and finally was withdrawn from the market.11 In a prospective study at 8 years follow-up, Mira Gon et al. evaluated the outcomes of Ophira implanted either as a first (20 patients) or repeated anti-incontinence procedure (20 women).12 Authors found that in the subgroup of naive patients Ophira demonstrated sustained results and no long-term complications.

To the best of our knowledge, this is the largest study available on the long-term (≥ 10 years) follow-up of SISs including a homogeneous population of naïve patients with pure SUI.

We stated that patients maintain excellent objective and subjective cure rates 10 years after SIS implantation. Moreover, no long-term mesh-related complications such as mesh exposure and chronic pain syndrome occurred, and patients’ satisfaction was very high.

Even with the limitations of the retrospective single-arm design and the discontinued surgical kit analyzed (Miniarc®), this study highlighted the need to investigate the long-term outcomes of SISs, as they have the potential to become a first-line treatment for SUI, like standard mid-urethral tapes. There is a need for randomized prospective clinical studies to define the role of SISs as an SUI treatment option.

Written by: Stefano Manodoro, MD, ASST Santi Paolo e Carlo, Ospedale San Paolo, via Antonio di Rudini, Milan, Italy, and Matteo Frigerio, MD, ASST Monza, San Gerardo Hospital, Monza, Italy


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