The comparison of the results of miniinvasive treatment of stress urinary incontinence using AjustTM and MiniArcTM system


Authors: Jan Krhut 1,2;  Alois Martan 3;  Marcel Gärtner 4;  Roman Zachoval 5;  Kamil Švabík 3;  Michal Halaška 6;  Lukáš Horčička 7;  Josef Tvrdík 8;  Tomáš Hanuš 9
Authors‘ workplace: Katedra chirugických oborů LF OU Ostrava 1;  Urologické oddělení FN, Ostrava-Poruba 2;  Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha 3;  Gynekologicko-porodnická klinika FN Ostrava-Poruba 4;  Urologické oddělení Fakultní Th omayerova nemocnice, Praha 5;  Gynekologicko-porodnická klinika FN Bulovka a 1. LF UK, Praha 6;  GONA spol. s r. o., Praha 7;  Přírodovědecká fakulta OU, Ostrava 8;  Urologická klinika 1. LF UK a VFN, Praha 9
Published in: Ces Urol 2012; 16(1): 20-28
Category: Original article

Overview

Aim:
The aim of the study was to compare the effectiveness of two minimally invasive surgical techniques for stress urinary incontinence in female patients (AjustTM and MiniArcTM), using subjective assessment as well as evaluation of objective parameters.

Methods:
A total of sixty-six female patients with stress urinary incontinence were enrolled into the prospective, randomized, multicentre trial, mean age 57.8 years (range 42–88 years). Patients in Group A had undergone surgery using AjustTM method; patients in Group B underwent surgery using the MiniArcTM method.

The subjective satisfaction of the patients along with the outcome of the procedure was evaluated using a standardized questionnaire “The International Consultation on Incontinence (ICI-Q)”. The objective assessment was performed with the use of cough test, urodynamics (bladder volume at the first desire to void – FDV, cytometric capacity – CC, maximum urethral closure pressure – MUCP, maximum urinary flow – Qmax), and ultrasound parameters (difference between the gamma –gammadif angles, distance between vesicourethral junction at rest and during the Valsalva maneuver – d). All of the parameters were measured prior to treatment, and three months following the surgical procedure. Statistical evaluation was performed with the two-choice t-testand nonparametric two-choice Wilcoxon’s test, with the correction for sequence alignment.

Results:
When assessing the subjective satisfaction ofthe procedure, we found, that both groups of patients reported a significant improvement in the total score (-14.09 ± 5.18 vs. -14.45 ±3.73), no significant difference was observed between the two methods (p = 0.74569). Objective assessment of the surgical procedure documented a lack of incontinence in a total of 61 patients (92.43%) following surgery. These included 31 patients (94%) from Group A and 30 patients from Group B (91%).

When we compared the urodynamic parameters before and after the surgery, we observed a significant increase of the cytometric capacity in patients of Group B. No other statistically significant differences between these two surgical procedures were observed in the other parameters.

A clear decrease in the uretrovesical junction mobility was observed in comparison with the pre-surgery measurements using introital sonography. We observed a decrease in the gamma angle (-13.82 ± 21.63 vs. -9.82 ± 17.17), as well as a shortening of the d line segment (-3.75 ± 6.93 vs. -3.53 ± 5.53). No statistically significant differences were observed between both methods of surgical treatment.

Conclusion:
Our initial experience with the surgical techniques AjustTM and MiniArcTM, with respect to the effectiveness and possible per- or postoperative complications, are good. From our assessment carried out at three-month follow up after the surgery it is apparent that the effectiveness of both surgical procedures are comparable. However, further follow-up is necessary for a definitive assessment of both methods.

Key words:
stress urinary incontinence, surgical treatment, minisling, AjustTM, MiniArcTM.


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Paediatric urologist Nephrology Urology
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