November 21st, 2014

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Title:
Comparison of the Efficacy and Safety of Surgical Procedures Utilizing Autologous Fascial and Transobturator Slings in Patients with Stress Urinary Incontinence
Authors:  Luiz Gustavo Oliveira Brito, M.D., Ph.D., Heitor Leandro Paiva Rodrigues, M.D., Maria ┬ngela Cury Ramos Carvalho, M.D., M.Sc., Pedro SÚrgio Magnani, M.D., Alessandro Henrique Antunes Lopes, M.D., and MaurÝcio Mesquita Sabino-de-Freitas, M.D., Ph.D.
  OBJECTIVE: To evaluate whether the conventional autologous fascial (AF) sling is superior or equal to the readjustable transobturator (TOT) sling in efficacy and safety in women with stress urinary incontinence (SUI).

STUDY DESIGN: This was a retrospective study comprised of a sample of 463 patients from 2003 to 2009. A total of 203 women received TOT slings for urodynamically confirmed SUI, and 260 patients received AF slings. We analyzed the subjective success rate (cure and/or improvement) after 12 and 24 months of surgery as well as any immediate and late surgical complications.

RESULTS: Both groups were statistically similar with regard to age, parity, body mass index, number of previous gynecological surgeries, and antiincontinence therapies. After 12 months patients with the TOT sling had a higher subjective percentage efficacy rate when compared to those with the AF sling (94% vs. 88%, p<0.05); however, after 24 months this percentage was no longer statistically significant (88.7% vs. 84.6%, p=0.20). The TOT sling presented fewer postoperative complication rates (14.1% vs. 25.6%, p<0.05), similar intraoperative complication rates (1.15% vs. 2.3%, p=0.22) and a shorter mean operative time (23 vs. 112 minutes, p< 0.05) than the AF sling.

CONCLUSION: Both techniques had similar subjective efficacy rates, but the TOT sling demonstrated fewer postoperative surgical complications than the AF sling.
Keywords:  autologous fascial sling, gynecologic surgery, transobturator sling, treatment efficacy, urinary stress incontinence
   
   
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