Jan Paul W. R. Roovers

Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices

OBJECTIVE We sought to determine and compare surgical therapeutic indices (STIs) of the retropubic tension-free vaginal tape (TVT) and 2 kinds of transobturator tape (TOT), Monarc (American Medical Systems, Minneapolis, MN), and tension-free vaginal tape obturator. STUDY DESIGN This was a retrospective cohort study. Patients with predominant stress urinary incontinence who underwent retropubic (TVT, n = 257) or TOT (n = 180) procedures were included. STIs for both groups were calculated by dividing cure by complication rate at, respectively, 2 and 12 months. RESULTS Two months after surgery the STI was significantly higher after TOT whereas 12 months after surgery results of STIs were equal. The explanation is more durable cure rates and declining long-term side effects after TVT procedures. CONCLUSION Both surgical approaches seem to have their own benefits. Based on the STI, the balance between cure rate and complications is on the short term in favor of TOT but on the long term similar for TOT and retropubic TVT.

Perspectives by patients and physicians on outcomes of mid-urethral sling surgery

Introduction and hypothesisThe aim of this study is to determine patient expectations regarding wanted and unwanted sequels of mid-urethral sling (MUS) procedures and to identify mismatches during the physician–patient information exchange prior to MUS procedures.MethodsA patient preference study (40 patients) and a questionnaire study with 20 experts as control group were conducted. Seventeen different sequels, defined by an expert team, were evaluated.ResultsBoth patients and expert physicians ranked cure and improvement of stress urinary incontinence as the most important goals of treatment. De novo urge urinary incontinence, requiring post-operative intermittent self-catheterisation and dyspareunia were considered to be the most important complications by patients. Time to resume work after the operation and dyspareunia were among the highest rated sequels in the patient group compared to re-operation and intra-operative complications in the expert group.ConclusionsNo differences were found in the five most important outcome parameters. In pre-operative counselling and future clinical trials, time to resume work and dyspareunia should be given more consideration by clinicians.