Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study

Objective: To evaluate and compare the clinical (patient’s morbidity, quality of life [QoL]) and economic impact of autologous vs synthetic slings in female stress urinary incontinence (SUI), as over the last decade, the introduction of synthetic vaginal tapes for managing SUI has gained wide accept...

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Autores principales:	Sherif Mourad, Hisham Elshawaf, Mahmoud Ahmed, Diaa Eldin Mostafa, Mohamed Gamal, Ahmed A. Shorbagy
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2018
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/75d87571a06d4d1186bf85ee9a724836
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spelling	oai:doaj.org-article:75d87571a06d4d1186bf85ee9a7248362021-12-02T12:24:08ZAutologous versus synthetic slings in female stress urinary incontinence: A retrospective study2090-598X10.1016/j.aju.2018.05.002https://doaj.org/article/75d87571a06d4d1186bf85ee9a7248362018-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X18300561https://doaj.org/toc/2090-598XObjective: To evaluate and compare the clinical (patient’s morbidity, quality of life [QoL]) and economic impact of autologous vs synthetic slings in female stress urinary incontinence (SUI), as over the last decade, the introduction of synthetic vaginal tapes for managing SUI has gained wide acceptance being quicker with low morbidity. Synthetic vaginal tapes have been progressively replacing the use of autologous rectus fascia. However, the high cost of these synthetic tapes is almost always an obstacle for most patients of limited socio-economic resources in the Egyptian community. Patients and methods: This retrospective study included 126 women with SUI. Data for patients that matched the study inclusion criteria were collected from the Urology Department of Ain-Shams University Hospitals from March 2011 to May 2013. Patients were categorised into two groups: Group I included 62 patients who underwent an autologous sling procedure using rectus sheath; and Group II included 64 patients that had a synthetic sling, using transobturator tape (TOT). The following variables were compared: operative time, postoperative pain scores, duration of indwelling urethral catheter, hospital stay, cost including the price of the synthetic tape when used, return to normal activity, and QoL assessment (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) before and after discharge from hospital. Results: Patients amongst the two groups were normally distributed with no statistically significant differences in patient’s demographic data and comorbidities. The mean hospital stay was longer and the return to normal activity was delayed in Group I compared to Group II. The highest mean postoperative pain score was recorded in Group I. The overall morbidity was 12.9% and 4.68% in groups I and II, respectively. The mean (SD) overall cost was 2571.65 (254.8) and 3502.34 (196.9) Egyptian pounds (local currency) in groups I and II, respectively, being insignificantly lower in Group I when compared to Group II (P > 0.05). There were statistically significant differences between groups I and II for operative time, hospital stay, and postoperative pain scores. However, the differences in hospital cost amongst Group I and Group II were in favour of Group I. Post-surgical outcome was categorised into either complete cure (dry) or improved or failed with no significant differences in success rate and QoL amongst the study groups. The mean (SD) change in the QoL score was 10.95 (4.19) and 12.32 (4.1) in groups I and II, respectively. The higher success rate (complete cure) was in Group II, at 93.75%. Also, a statistically significant improvement of >70% of mean ICIQ-UI-SF score was shown in all groups when compared to baseline on both the 1- and 6-month follow-up visits. Conclusion: Autologous grafts should be considered as a repair option in females with SUI in countries were health insurance policies do not cover the cost of synthetic materials in many instances. The cost-effectiveness of synthetic TOT slings, as a minimally invasive procedure with lower overall morbidity, has yet to be confirmed in larger scale studies with longer periods of follow-up, to confirm the durability of its successful outcomes and be considered as the primary treatment of choice in female SUI. Keywords: Stress urinary incontinence, Autologous slingSherif MouradHisham ElshawafMahmoud AhmedDiaa Eldin MostafaMohamed GamalAhmed A. ShorbagyTaylor & Francis GrouparticleDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 16, Iss 4, Pp 397-403 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Sherif Mourad Hisham Elshawaf Mahmoud Ahmed Diaa Eldin Mostafa Mohamed Gamal Ahmed A. Shorbagy Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study
description	Objective: To evaluate and compare the clinical (patient’s morbidity, quality of life [QoL]) and economic impact of autologous vs synthetic slings in female stress urinary incontinence (SUI), as over the last decade, the introduction of synthetic vaginal tapes for managing SUI has gained wide acceptance being quicker with low morbidity. Synthetic vaginal tapes have been progressively replacing the use of autologous rectus fascia. However, the high cost of these synthetic tapes is almost always an obstacle for most patients of limited socio-economic resources in the Egyptian community. Patients and methods: This retrospective study included 126 women with SUI. Data for patients that matched the study inclusion criteria were collected from the Urology Department of Ain-Shams University Hospitals from March 2011 to May 2013. Patients were categorised into two groups: Group I included 62 patients who underwent an autologous sling procedure using rectus sheath; and Group II included 64 patients that had a synthetic sling, using transobturator tape (TOT). The following variables were compared: operative time, postoperative pain scores, duration of indwelling urethral catheter, hospital stay, cost including the price of the synthetic tape when used, return to normal activity, and QoL assessment (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) before and after discharge from hospital. Results: Patients amongst the two groups were normally distributed with no statistically significant differences in patient’s demographic data and comorbidities. The mean hospital stay was longer and the return to normal activity was delayed in Group I compared to Group II. The highest mean postoperative pain score was recorded in Group I. The overall morbidity was 12.9% and 4.68% in groups I and II, respectively. The mean (SD) overall cost was 2571.65 (254.8) and 3502.34 (196.9) Egyptian pounds (local currency) in groups I and II, respectively, being insignificantly lower in Group I when compared to Group II (P > 0.05). There were statistically significant differences between groups I and II for operative time, hospital stay, and postoperative pain scores. However, the differences in hospital cost amongst Group I and Group II were in favour of Group I. Post-surgical outcome was categorised into either complete cure (dry) or improved or failed with no significant differences in success rate and QoL amongst the study groups. The mean (SD) change in the QoL score was 10.95 (4.19) and 12.32 (4.1) in groups I and II, respectively. The higher success rate (complete cure) was in Group II, at 93.75%. Also, a statistically significant improvement of >70% of mean ICIQ-UI-SF score was shown in all groups when compared to baseline on both the 1- and 6-month follow-up visits. Conclusion: Autologous grafts should be considered as a repair option in females with SUI in countries were health insurance policies do not cover the cost of synthetic materials in many instances. The cost-effectiveness of synthetic TOT slings, as a minimally invasive procedure with lower overall morbidity, has yet to be confirmed in larger scale studies with longer periods of follow-up, to confirm the durability of its successful outcomes and be considered as the primary treatment of choice in female SUI. Keywords: Stress urinary incontinence, Autologous sling
format	article
author	Sherif Mourad Hisham Elshawaf Mahmoud Ahmed Diaa Eldin Mostafa Mohamed Gamal Ahmed A. Shorbagy
author_facet	Sherif Mourad Hisham Elshawaf Mahmoud Ahmed Diaa Eldin Mostafa Mohamed Gamal Ahmed A. Shorbagy
author_sort	Sherif Mourad
title	Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study
title_short	Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study
title_full	Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study
title_fullStr	Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study
title_full_unstemmed	Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study
title_sort	autologous versus synthetic slings in female stress urinary incontinence: a retrospective study
publisher	Taylor & Francis Group
publishDate	2018
url	https://doaj.org/article/75d87571a06d4d1186bf85ee9a724836
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Autologous versus synthetic slings in female stress urinary incontinence: A retrospective study

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