Do different vaginal tapes need different suburethral incisions? The one-half rule
2014; Wiley; Volume: 34; Issue: 8 Linguagem: Inglês
10.1002/nau.22658
ISSN1520-6777
AutoresVolker Viereck, Andrzej Kuszka, Oliver Rautenberg, Edyta Wlaźlak, Grzegorz Surkont, Reinhard Hilgers, Jakob Eberhard, Jacek Kociszewski,
Tópico(s)Pelvic and Acetabular Injuries
ResumoNeurourology and UrodynamicsVolume 34, Issue 8 p. 741-746 Clinical Science Do different vaginal tapes need different suburethral incisions? The one-half rule Volker Viereck, Volker Viereck Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland Department of Obstetrics and Gynecology, Georg August University Goettingen, GermanySearch for more papers by this authorAndrzej Kuszka, Andrzej Kuszka Department of Obstetrics and Gynecology, Lutheran Hospital Hagen-Haspe, GermanySearch for more papers by this authorOliver Rautenberg, Oliver Rautenberg Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, SwitzerlandSearch for more papers by this authorEdyta Wlaźlak, Edyta Wlaźlak Department of Obstetrics and Gynecology, Medical University of Lodz, Lodz, PolandSearch for more papers by this authorGrzegorz Surkont, Grzegorz Surkont Department of Obstetrics and Gynecology, Medical University of Lodz, Lodz, PolandSearch for more papers by this authorReinhard Hilgers, Reinhard Hilgers Institute of Medical Statistics, Georg August University, Goettingen, GermanySearch for more papers by this authorJakob Eberhard, Jakob Eberhard Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, SwitzerlandSearch for more papers by this authorJacek Kociszewski, Corresponding Author Jacek Kociszewski Department of Obstetrics and Gynecology, Lutheran Hospital Hagen-Haspe, Germany Correspondence to: Dr. Jacek Kociszewski, M.D., Department of Gynecology and Obstetrics Lutheran Hospital Hagen-Haspe Brusebrinkstraße 20 58135 Hagen, Germany. E-mail: [email protected]Search for more papers by this author Volker Viereck, Volker Viereck Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland Department of Obstetrics and Gynecology, Georg August University Goettingen, GermanySearch for more papers by this authorAndrzej Kuszka, Andrzej Kuszka Department of Obstetrics and Gynecology, Lutheran Hospital Hagen-Haspe, GermanySearch for more papers by this authorOliver Rautenberg, Oliver Rautenberg Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, SwitzerlandSearch for more papers by this authorEdyta Wlaźlak, Edyta Wlaźlak Department of Obstetrics and Gynecology, Medical University of Lodz, Lodz, PolandSearch for more papers by this authorGrzegorz Surkont, Grzegorz Surkont Department of Obstetrics and Gynecology, Medical University of Lodz, Lodz, PolandSearch for more papers by this authorReinhard Hilgers, Reinhard Hilgers Institute of Medical Statistics, Georg August University, Goettingen, GermanySearch for more papers by this authorJakob Eberhard, Jakob Eberhard Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, SwitzerlandSearch for more papers by this authorJacek Kociszewski, Corresponding Author Jacek Kociszewski Department of Obstetrics and Gynecology, Lutheran Hospital Hagen-Haspe, Germany Correspondence to: Dr. Jacek Kociszewski, M.D., Department of Gynecology and Obstetrics Lutheran Hospital Hagen-Haspe Brusebrinkstraße 20 58135 Hagen, Germany. E-mail: [email protected]Search for more papers by this author First published: 30 August 2014 https://doi.org/10.1002/nau.22658Citations: 11 Eric Rovner led the peer-review process as the Associate Editor responsible for the paper. Potential conflicts of interest: Nothing to disclose. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Aim Despite a wide array of vaginal tapes to treat stress urinary incontinence (SUI), evidence suggesting that both patient characteristics and tape positioning influence outcomes, and differing tape insertion pathways (retropubic vs. transobturator), it remains unclear if the same incision location is effective for all tapes. The aim of the study was to compare outcomes using two different surgical incision locations when inserting a transobturator vaginal tape (TOT) to treat SUI. Methods We compared patient characteristics, tape positioning, and surgical outcomes in 123 women undergoing a TOT procedure who were randomly assigned to have the surgical incision begin at 1/3 of the sonographically-measured urethral length (similar to the traditional retropubic approach) or 1/2 of the urethral length. Results It was feasible to place the tape according to intention in 99.2% of the study cohort. The overall cure rate was higher when the incision site began at 1/2 the urethral length (83.6%) than 1/3 (62.9%) (P = 0.01). In the subgroup analyses, only patients with normal urethral mobility had significantly different cure rates (85.7% vs. 55.2%, P = 0.02). No significant differences in cure rates were observed between the other mobility categories of the study groups—hypermobility was consistently associated with high cure rates and hypomobility with low cure rates. Conclusions When surgically treating SUI with a TOT, incision at the mid-urethra using the 1/2 rule is recommended as it leads to better outcomes for most patients, particularly those with normal urethral mobility. Neurourol. Urodynam. 34:741–746, 2015. © 2014 Wiley Periodicals, Inc. REFERENCES 1 Westby M, Asmussen M, Ulmsten U. Location of maximum intraurethral pressure related to urogenital diaphragm in the female subject as studied by simultaneous urethrocystometry and voiding urethrocystography. 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