A comparison of different types of suburethral slings in the treatment of urinary incontinence in geriatric patients

Czech version

Authors: O. Šottner ¹; M. Halaška ¹; J. Vláčil ¹; K. Maxová ¹; I. Malá ⁴; R. Krombholz ³; MJ. Halaška ²
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a Nemocnice Na Bulovce, přednosta prof. MUDr. M. Halaška, DrSc. ¹; Gynekologicko-porodnická klinika 2. LF UK a FN Motol, přednosta prof. MUDr. L. Rob, Ph. D. ²; Gerontologické oddělení Psychiatrické léčebny Bohnice, přednosta prim. MUDr. R. Krombholz ³; Fakulta informatiky a statistiky, Katedra statistiky a pravděpodobnosti VŠE, Praha ⁴
Published in: Ceska Gynekol 2012; 77(5): 403-407

Overview

Objective:
Comparison of different types of tension free tapes in the treatment of urinary incontinence in institutionalized elderly patients.

Design:
Prospective randomized study.

Setting:
Charles University in Prague, 1^st Medical Faculty and Hospital Bulovka, Department of Obstetrics and Gynaecology, Prague.

Methods:
43 patients of several gerontologic centres with prevailing stress urinary incontinence were included based on urinary dysfunction specific questionnaire (ICIQ) and cognitive functions objective estimation (MMSE). Three types of tapes, TVT-O, MiniArc and Ajust were used and patients were randomized into the groups and after an urogynaecologic examination, incl. ultrasound the operation was performed.

Results:
The groups were –⁠ except of the age of the patients of group MiniArc –⁠ well outweighted concerning demographic parameters. High success rate of all techniques used evaluated by the QoL questionnaires was in all the groups comparable. No case of bleeding, bladder injury or postoperative pain was found. Higher frequency of OAB de novo and worsening of preexisting symptomatics could be explained by general very high prevalence of OAB in the elderly even without the operation. In whole our cohort only 1 case of failure to treat and of tape exposure was found.

Our results confirming high success rate of all the types also in elderly and institutionalized patients are in consent with sporadic published data.

Conclusion:
Surgical treatment of cases of stress and mixed urinary incontinence is also in cases of elderly polymorbid nurcing facilities clients with regard to the high success rate. Secondary outcome of our report when accepting the conclusion is drop of the costs of antiincontinence pads thus having a significant economic effect.

Key words:
urinary incontinence, geriatric patient, suburethral vaginal tape.

Sources

1. Abdel-Fattah, M., Agur, W., Abdel-All, M., et al. Prospective multi-centre study of adjustable single-incision mini-sling (Ajust((R)) ) in the management of stress urinary incontinence in women: 1-year follow-up study. BJU Int, 2011.

2. Agarwala, N., Hasiak, N., Shade, M. Graft interposition colpocleisis, perineorrhaphy, and tension-free sling for pelvic organ prolapse and stress urinary incontinence in elderly patients. J Minim Invasive Gynecol, 2007, 146, p. 740–745.

3. Aslan, E., Beji, NK., Erkan, HA., et al. Urinary incontinence (UI) and quality of life (QoL) of the elderly residing in residential homes in Turkey. Arch Gerontol Geriatr, 2009, 492, p. 304–310.

4 Barber, MD., Walter, MD., Bump, RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol, 2005, 1931, p. 103–113.

5 Campeau, L., Tu, LM., Lemieux, MC., et al. A multicenter, prospective, randomized clinical trial comparing tension-free vaginal tape surgery and no treatment for the management of stress urinary incontinence in elderly women. Neurourol Urodyn, 2007, 26 (7), p. 990–994.

6. Cherniack, EP. Biofeedback and other therapies for the treatment of urinary incontinence in the elderly. Altern Med Rev, 2006, 113, p. 224–231.

7. de Leval, J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol, 2003, 446, p. 724–730.

8. Delorme, E. [Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women]. Prog Urol, 2001, 116, p. 1306–1313.

9. Delorme, E., Droupy, S., de TR, Delmas, V. [Transobturator tape (Uratape). A new minimally invasive method in the treatment of urinary incontinence in women]. Prog Urol, 2003, 134, p. 656–659.

10. DuBeau, CE., Kuchel, GA., Johnson, T., et al. Incontinence in the frail elderly: report from the 4th International Consultation on Incontinence. Neurourol Urodyn, 2010, 291, p. 165–178.

11. Gibbs, CF., Johnson, TM., Ouslander, JG. Office management of geriatric urinary incontinence. Am J Med, 2007, 1203, p. 211–220.

12. Kim, H., Suzuki, T., Yoshida, Y., Yoshida, H. Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community-dwelling Japanese women: a randomized, controlled, crossover trial. J Am Geriatr Soc, 2007, 5512, p. 1932–1939.

13. Lawhorne, LW., Ouslander, JG., Parmelee, PA., et al. Urinary incontinence: a neglected geriatric syndrome in nursing facilities. J Am Med Dir Assoc, 2008, 91, p. 29–35.

14. Lee, KS., Lee, YS., Seo, JT., et al. A prospective multicenter randomized comparative study between the U -⁠ and H-type methods of the TVT SECUR procedure for the treatment of female stress urinary incontinence: 1-year follow-up. Eur Urol, 2010, 576, p. 973–979.

15. Martan, A., Svabik, K., Halaska, M., et al. Vyhodnocení prvých zkušeností s bezpečností a krátkodobým efektem mini-páskových antiinkontinentních operací MiniArc a AJUST. Čes Gynek, 2011, 765, p. 349–355.

16. Moore, RD., Mitchell, GK., Miklos, JR. Single-center retrospective study of the technique, safety, and 12-month efficacy of the MiniArc single-incision sling: a new minimally invasive procedure for treatment of female SUI. Surg Technol Int, 2009, 18, p. 175–181.

17. O’Donnell, PD. Special considerations in elderly individuals with urinary incontinence. Urology, 1998, 512A, Suppl, p. 20–23.

18. Touloupidis, S., Papatsoris, AG,, Thanopoulos, C., et al. Tension-free vaginal tape for the treatment of stress urinary incontinence in geriatric patients. Gerontology, 2007, 533, p. 125–127.

19. Ulmsten, U., Petros, P. Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol, 1995, 291, p. 75–82.