Commented Abstracts

Our experience with mini tapes (TVT Secur and MiniArc)
in the surgery for stress urinary incontinence.
Actas Urológicas Españolas; 32(10):1013-1018, 2008.

Jiménez Calvo J, Hualde Alfaro A, Raigoso Ortega O,
Cebrian Lostal JL, Alvarez Bandres S, Jiménez Parra J,
Montesino Semper M, Santiago Gonzalez de Garibay A.
Servicio de Urología, Hospital Virgen del Camino, Pamplona, Navarra. auvc03@yahoo.es

BACKGROUND: The purpose of this publication is to describe the surgical technique, assess complications and short-term results of TVT secur and MiniArc tapes. MATERIALS AND

METHODS: From October 2006 to August 2007 it was carried out the surgical correction with TVT Secur, Women's Health & Urology, Ethicon, Johnson & Johnson, placing the tape as a hammock, to 51 patients, 38 of them with pure stress incontinence and 13 with mixed incontinence and with an average age of 57 years. From September 2007 to February 2008 41 patients, 33 of them with pure stress incontinence and 8 with mixed incontinence, with an average of age of 58 years were operated with AMS Miniarc swing system tape, posted on hammock. All procedures were performed with sedoanalgesia and Ambulatory Surgery regime. Patients were monitored in outpatient visits one month, 3 months and one year after surgical procedure. Medical history and questionnaire and ICIQ-SF, to which we added a question to quantify the degree of satisfaction, as well as physical examination, were done. We compared the results of both technical procedures and statistical survey was conducted by Student test. [Analysis with SPSS software (V14.0)].

RESULTS: The median follow-up in TVT secur group was 328 days (range 163-522 days) and 101 days (range 41-209 days) in the MiniArc group. We only had one (TVT secur group) surgical complication in all the series (92 patients) being a bladder perforation. Taking into account that we read a negative test effort as an objective cure in the TVT secur group, 80.4% patients are cured and 90.2% in the MiniArc group without significant difference between both groups (p 0095). To assess the subjective healing we utilized the ICIQ-SF test and the satisfaction extra-question and we noted that there is no significant difference between the first and third month controls. (90% of patients satisfied). 80% of patients were completely satisfied in the first year control that was only performed to TVT secur group.

CONCLUSION: These new tapes show fewer complications that the TVT-O and TOT tapes and allow the possibility of placement with local anesthesia but further studies are needed.

Key words: Incontinence. TVT secur. MiniArc.

Editor’s comment

TVT was launched in 1996 aiming at reinforcing the posterior portion of the middle urethra allowing for a firm support in the main zone responsible for urinary incontinence. Regardless of the “minimally invasive” characteristic and the satisfactory success rates, morbidity is not negligible, especially bladder perforations, infra-bladder obstruction and, rarely, vascular complications or intestinal lesions, and some cases of postoperative death. Recently, in 2001, the transobturator access was introduced, which would have the advantage of causing less damage to the bladder, intestine and large vessels, and a lower incidence of micturition dysfunction. Although these procedures can be performed in an outpatient basis, under local anesthesia and sedation, some of these possible complications have made it more prudent to perform it under spinal anesthesia. In order to reduce morbidity, minislings (TVT secur) in 2006 and the MiniArc in 2007 were released to the market. Sling length (around 8 cm) and the way they are placed allow the procedure to be carried out in an outpatient basis, reducing expenditures (hospital stay and anesthesia) and, theoretically, reduce morbidity. Nonetheless, there are only short-follow-up studies, usually less than one year, and with initial results which are lower than the ones obtained from retropubic slings and the classic transobturative ones. If, on the one hand, the shorter length and the way to place the sling reduce the likelihood of damage to pelvic structures, such advantage can be overcome by the disadvantage of a possibly inadequate sub-urethral tape fixation, shifting and loss of efficiency in the long run. Only long term studies, those of at least 5 years, can answer this question and, until then, it is more prudent to consider TVT secur and the Mini Arc as “experimental’ procedures.

Aparecido Donizeti Agostinho