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

Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices,10.1016/j.ajog.2009.07.043,

Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices   (Citations: 4)
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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
Journal: American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL , vol. 202, no. 1, pp. 75.e1-75.e7, 2010
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    • ...complications possibly due to minimal inflammatory reaction without a significant change in collagen solubility [1].The rate of wound infection after midurethral slings is 0–2% [2, 9-11]...
    • ...Mesh exposure, either as a result of incomplete wound healing or erosion through the epithelial layer after placement, is also within 1% when polypropylene mesh is used [2, 9-11]...
    • ...[2, 9-11] In the combined subanalysis of women from SISTEr and TOMUS trials, UTI within six postoperative weeks occurred in 12% and 7% of women undergoing retropubic and transobturator slings, respectively [13]...
    • ...In order to detect a 50% reduction in wound-related complications (infection and/or mesh exposure) from the current 3% rate as seen in large randomized trials [2, 9-11] to 1.5% and have an 80% power and 95% statistical significance, a prospective, randomized blinded study should include at least 4,000 patients...

    Oz Harmanliet al. Double-blinded randomized trial of preoperative antibiotics in miduret...

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