Skip to main content
Top
Published in: International Urogynecology Journal 9/2012

01-09-2012 | Original Article

Ajust single incision transobturator sling procedure for stress urinary incontinence: results after 1-year follow-up

Authors: Jean-Nicolas Cornu, Laurence Peyrat, Ariela Skurnik, Calin Ciofu, Vincent R. Lucente, Francois Haab

Published in: International Urogynecology Journal | Issue 9/2012

Login to get access

Abstract

Introduction and hypothesis

Data on the Ajust™, a new single-incision sling procedure for female stress urinary incontinence (SUI) management, remain scarce and limited to a 1-year follow-up. Our goal was to assess the efficacy of this procedure after a 1-year follow-up.

Methods

This prospective evaluation involved 95 consecutive patients implanted with AjustTM at a single centre. All patients had SUI on urodynamics due to urethral hypermobility, 33 % had preoperative overactive bladder (OAB) symptoms and none had detrusor overactivity. Ninety-two patients were treated on an outpatient basis, and 3 patients had general anaesthesia. Postoperative assessment was conducted at 1, 6, 12 months, and yearly thereafter. The main outcome measure was pad usage. Secondary parameters were self-reported SUI episodes, OAB symptoms, data of clinical examination, satisfaction using the Patient Global Impression of Improvement (PGI-I) scale, postoperative pain, and adverse events.

Results

After a mean follow-up of 21 ± 6 months (12–32), 76 out of 95 patients used no pads or one dry security pad, showing a success rate of 80 %. Seventy-nine out of 95 patients had no more SUI-related leakage. Only 6 patients experienced late recurrence of SUI after 6 months’ follow-up. Perioperative complications included 1 case of vaginal hematoma, 1 case of acute urinary retention, 2 cases of urinary tract infection, all managed conservatively. Half of the patients had no pain after day 1, free of medications. Late complications were vaginal erosion in 1 case, and pain during exertion in 2 cases.

Conclusions

The AjustTM single incision transobturator sling is a safe and effective procedure, with durable results after 1 year.
Literature
2.
go back to reference Lasserre A, Pelat C, Guéroult V et al (2009) Urinary incontinence in French women: prevalence, risk factors, and impact on quality of life. Eur Urol 56:177–83PubMedCrossRef Lasserre A, Pelat C, Guéroult V et al (2009) Urinary incontinence in French women: prevalence, risk factors, and impact on quality of life. Eur Urol 56:177–83PubMedCrossRef
3.
go back to reference Coyne KS, Wein AJ, Tubaro A et al (2009) The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int 103(S3):4–11PubMedCrossRef Coyne KS, Wein AJ, Tubaro A et al (2009) The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int 103(S3):4–11PubMedCrossRef
4.
go back to reference Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26PubMedCrossRef Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26PubMedCrossRef
5.
go back to reference Novara G, Ficarra V, Boscolo-Berto R, Secco S, Cavalleri S, Artibani W (2007) Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol 52:663–78PubMedCrossRef Novara G, Ficarra V, Boscolo-Berto R, Secco S, Cavalleri S, Artibani W (2007) Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol 52:663–78PubMedCrossRef
6.
go back to reference Richter HE, Albo ME, Zyczynski HM et al (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362:2066–2076PubMedCrossRef Richter HE, Albo ME, Zyczynski HM et al (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362:2066–2076PubMedCrossRef
7.
go back to reference Abdel-Fattah M, Ford JA, Lim CP, Madhuvrata P (2011) Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications. Eur Urol 60:468–480PubMedCrossRef Abdel-Fattah M, Ford JA, Lim CP, Madhuvrata P (2011) Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications. Eur Urol 60:468–480PubMedCrossRef
8.
go back to reference Meschia M, Barbacini P, Baccichet R et al (2011) Short-term outcomes with the Ajust™ system: a new single incision sling for the treatment of stress urinary incontinence. Int Urogynecol Pelvic Floor Dysfunct 22:177–182CrossRef Meschia M, Barbacini P, Baccichet R et al (2011) Short-term outcomes with the Ajust™ system: a new single incision sling for the treatment of stress urinary incontinence. Int Urogynecol Pelvic Floor Dysfunct 22:177–182CrossRef
9.
go back to reference Mostafa A, Agur W, Abdel-All M et al (2011) A multicentre randomized trial comparing single-incision mini-sling (AJUST©) and tension-free vaginal tape-obturator (TVT-O)in management of female stress urinary incontinence. Int Urogynecol J 22(S1):S5–S7 Mostafa A, Agur W, Abdel-All M et al (2011) A multicentre randomized trial comparing single-incision mini-sling (AJUST©) and tension-free vaginal tape-obturator (TVT-O)in management of female stress urinary incontinence. Int Urogynecol J 22(S1):S5–S7
10.
go back to reference Abdel-Fattah M, Agur W, Abdel-All M et al (2011) Prospective multicentre study of adjustable single-incision mini-sling (Ajust®) in the management of stress urinary incontinence in women: 1-year follow-up study. BJU Int 109:880–886PubMedCrossRef Abdel-Fattah M, Agur W, Abdel-All M et al (2011) Prospective multicentre study of adjustable single-incision mini-sling (Ajust®) in the management of stress urinary incontinence in women: 1-year follow-up study. BJU Int 109:880–886PubMedCrossRef
11.
go back to reference Abrams P, Andersson KE, Birder L et al (2010) Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 29:213–240PubMedCrossRef Abrams P, Andersson KE, Birder L et al (2010) Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 29:213–240PubMedCrossRef
12.
go back to reference Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189:98–101PubMedCrossRef Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189:98–101PubMedCrossRef
13.
go back to reference Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29:75–82PubMedCrossRef Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29:75–82PubMedCrossRef
14.
go back to reference Liapis A, Bakas P, Creatsas G (2002) Burch colposuspension and tension free vaginal tape for the management of stress urinary incontinence in women. Eur Urol 41:469–473PubMedCrossRef Liapis A, Bakas P, Creatsas G (2002) Burch colposuspension and tension free vaginal tape for the management of stress urinary incontinence in women. Eur Urol 41:469–473PubMedCrossRef
15.
go back to reference Fong ED, Nitti VW (2010) Review article: mid-urethral synthetic slings for female stress urinary incontinence. BJU Int 106:596–608PubMedCrossRef Fong ED, Nitti VW (2010) Review article: mid-urethral synthetic slings for female stress urinary incontinence. BJU Int 106:596–608PubMedCrossRef
16.
go back to reference Daneshgari F, Kong W, Swartz M (2008) Complications of mid urethral slings: important outcomes for future clinical trials. J Urol 180:1890–1897PubMedCrossRef Daneshgari F, Kong W, Swartz M (2008) Complications of mid urethral slings: important outcomes for future clinical trials. J Urol 180:1890–1897PubMedCrossRef
17.
go back to reference Rehman H, Bezerra CC, Bruscini H, Cody JD (2011) Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev CD001754 Rehman H, Bezerra CC, Bruscini H, Cody JD (2011) Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev CD001754
18.
go back to reference Nilsson CG, Kuuva N (2001) The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. BJOG 108:414–419PubMedCrossRef Nilsson CG, Kuuva N (2001) The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. BJOG 108:414–419PubMedCrossRef
19.
go back to reference Paick JS, Ku JH, Kim SW, Oh SJ, Son H, Shin JW (2004) Tension-free vaginal tape procedure for the treatment of mixed urinary incontinence: significance of maximal urethral closure pressure. J Urol 172:1001–1005PubMedCrossRef Paick JS, Ku JH, Kim SW, Oh SJ, Son H, Shin JW (2004) Tension-free vaginal tape procedure for the treatment of mixed urinary incontinence: significance of maximal urethral closure pressure. J Urol 172:1001–1005PubMedCrossRef
20.
go back to reference Paick JS, Oh SJ, Kim SW, Ku JH (2008) Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct 19:123–129PubMed Paick JS, Oh SJ, Kim SW, Ku JH (2008) Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct 19:123–129PubMed
21.
go back to reference Holmgren C, Nilsson S, Lanner L, Hellberg D (2005) Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol 106:38–43PubMedCrossRef Holmgren C, Nilsson S, Lanner L, Hellberg D (2005) Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol 106:38–43PubMedCrossRef
22.
go back to reference Holmgren C, Nilsson S, Lanner L, Hellberg D (2007) Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence—a long-term follow-up. Eur J Obstet Gynecol Reprod Biol 132:121–125PubMedCrossRef Holmgren C, Nilsson S, Lanner L, Hellberg D (2007) Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence—a long-term follow-up. Eur J Obstet Gynecol Reprod Biol 132:121–125PubMedCrossRef
23.
go back to reference Long CY, Hsu CS, Wu MP, Liu CM, Wang TN, Tsai EM (2009) Comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence. Curr Opin Obstet Gynecol 21:342–347PubMedCrossRef Long CY, Hsu CS, Wu MP, Liu CM, Wang TN, Tsai EM (2009) Comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence. Curr Opin Obstet Gynecol 21:342–347PubMedCrossRef
Metadata
Title
Ajust single incision transobturator sling procedure for stress urinary incontinence: results after 1-year follow-up
Authors
Jean-Nicolas Cornu
Laurence Peyrat
Ariela Skurnik
Calin Ciofu
Vincent R. Lucente
Francois Haab
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
International Urogynecology Journal / Issue 9/2012
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-012-1740-0

Other articles of this Issue 9/2012

International Urogynecology Journal 9/2012 Go to the issue

Debate: Robotic Versus Straight-Stick Laparoscopy

The case for conventional laparoscopic sacrocolpopexy