16 Jun 2007 ... 3DUS was performed using a GE Kretz Voluson 730/730 Expert with a ......
information leaflet to get a fully informed valid consent. Pre-.
Int Urogynecol J (2007) 18 (Suppl 1):S1–S24 DOI 10.1007/s00192-007-0384-y
2007 IUGA ABSTRACTS
Oral Presentations 32nd Annual IUGA Meeting, Cancún, Mexico, 12–16 June 2007
001 OUTCOME MEASURES AND DEFINITIONS OF CURE IN FEMALE STRESS URINARY INCONTINENCE SURGERY Castillo, P; Davila, GW Cleveland Clinic, Weston, FL, USA Objective: To evaluate outcome measures utilized in defining success following anti-incontinence procedures for stress urinary incontinence in females. Materials and methods: A Medline search of indexed peer review journals between January 2005 and December 2006 was performed. Criteria for articles included in this study were based on primary surgical treatment of female stress incontinence. Non-indexed journals, case reports, studies involving treatment of male stress incontinence, studies that did not focus on post surgical outcome and non-surgical management of failed anti-incontinence procedures were excluded from this review. Data including mean follow-up, specific outcome measures used, success rates and definition of cure in each study were tabulated and analyzed.
Objective Cough stress test (all variations) Pad test (all variations) Urodynamics
Combination
OUTCOME MEASURES N (%) Subjective 46 (52) Self assessment 20 (23)
Voiding diary
21 (24)
Questionnaires Validated Non-validated QOL questionnaires
10 (11)
N (%) 44 (50) 2 (2.3)
31 (35) 19 (22) 33 (38)
DEFINITION OF CURE Measures used N (%) Subjective only 4 (5) Objective only 28 (32) Combination 56 (64)
Results: A total of 88 published studies from 26 journals by 80 principal authors were reviewed including 17 randomized control trials, 28 retrospective studies, and 43 prospective cohort studies. The number of patients in each study ranged from 4–809 with a mean follow-up range of 1–96 months. Outcome measures that were utilized and definitions of cure from these studies are tabulated.
Conclusion: This review strongly suggests the need for consensus or standardization in the choice of outcome measures and method of defining cure following antiincontinence procedures. Disclosures Was consent obtained from patients? N/a. Was this work supported by industry? No. Does the presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry? Yes.
002 TRANSOBTURATOR AND RETROPUBIC TAPE PROCEDURES IN STRESS URINARY INCONTINENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF EFFECTIVENESS AND COMPLICATIONS Latthe, P; Foon, R; Toozs-Hobson, P Birmingham Women’s Hospital, UK Objective: To assess the effectiveness and complications of transobturator tape in stress urinary incontinence (SUI) by means of a systematic review Material and methods Search strategy: MEDLINE, EMBASE, CINAHL, LILIACS (up to September 2006), CENTRAL (The Cochrane Library, Issue 3, 2006), MetaRegister of Controlled Trials, The National Library for Health, the National Research Register and Google Scholar were searched using various relevant search terms. The citation lists of review articles and included trials were searched and contact with the corresponding author of each included trials was attempted. Selection criteria, data collection and analysis: Randomised controlled trials (RCTs) which compared effectiveness of TVTO or TOT with synthetic tension free transvaginal tape by retropubic route (TVT- Gynecare, ETHICON, INC., a Johnson & Johnson company) for the treatment of SUI in all languages were included. Two reviewers extracted data on participants’ characteristics, study quality, population, intervention, cure and adverse effects independently. The data was analysed in the Review Manager 4.2.8 software.
S2
Results: There were 5 RCTs that compared TVTO with TVT and 6 RCTs that compared TOT versus tension free vaginal tape (TVT) by retropubic route for the treatment of SUI. When compared by subjective cure, TVTO and TOT at 2–12 months were no better when compared to TVT (OR 0.85; 95% CI 0.60–1.21). Adverse events such as bladder injuries (OR 0.12; 95% CI 0.05–0.33) and voiding difficulties (OR 0.55; 95% CI 0.31–0.98) were less common whereas groin/thigh pain (OR 8.28; 95% CI 2.7– 25.4) and vaginal injuries or erosion of mesh (OR 1.96; 95% CI 0.87–4.39) were more common in tapes inserted by transobturator route. Conclusion: The evidence for short term superiority of effectiveness of transobturator tapes is currently limited. Bladder injuries and voiding difficulties are lower but the risk of vaginal erosions and groin pain is higher with TVTO/TOT. Methodologically sound and sufficiently powered RCTs with long term follow up are needed and the results of ongoing trials are awaited. Disclosures Was consent obtained from patients? N/a. Was this work supported by industry? No. Does the presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry? No.
003 A MULTICENTER RANDOMIZED COMPARISON OF TENSION-FREE VAGINAL TAPE (TVT) AND TRANS-OBTURATOR IN-OUT TECHNIQUE (TVT-O) FOR THE TREATMENT OF STRESS URINARY INCONTINENCE: ONE YEAR RESULTS Meschia, M1; Pifarotti, P2; Baccichet, R3; Bernasconi, F4; Cortese, P5; Magatti, F6; Minini, G7 1 Ospedale G. Fornaroli, Magenta, Italy; 2Ospedale L Mangiagalli, Milano, Italy; 3Ospedale Conegliano, Italy; 4 Ospedale Desio, Italy; 5Ospedale S Anna Torino, Italy; 6 Ospedale Como, Italy; 7Ospedale Brescia, Italy
Aim: To compare the efficacy and morbidity of retropubic (TVT) and trans-obturator suburethral sling (TVT-O) in the treatment of stress urinary incontinence. Methods: Patients with urodynamic stress urinary incontinence and urethral hypermobility were randomized to treatments according to a centralized computer-generated random list. On the assumption of 90% cure rate after TVT it was calculated that 190 patients would be required (95 in each arm) to detect a clinically significant difference of 15% in cure rate between procedures with 80% power and an α level of 0,05. The pre- and postoperative protocol
Int Urogynecol J (2007) 18 (Suppl 1):S1–S24
included the following: a detailed urogynecologic history, a physical examination, and a multichannel urodynamic evaluation. The ICI-SF, W-IPSS, PGI-S questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure patient’s perception of incontinence severity. The primary outcome measure was rate of success for both procedures, the secondary outcome measure was rate of complications. Intra-operative data were collected as well as those of early post-operative course. The outcome of surgical treatment was estimated both subjectively and objectively using the same tools as before surgery and the PGI-I questionnaire was added. All patients were informed about the study and procedure and gave their informed consent. The Statistical Package for Social Sciences was used for data analysis. Probability values of
