SLING AD INCISIONE SINGOLA

PRO & contro

SOC Ostetricia – Ginecologia Montecchio Emilia

Direttore : Dott Roberto Baccichet

Anterior repairs

Retropubic operations

Tension-free synthetic slingse.g. SPARC® , TVT®

Needle Suspensions

Autologous/Graft PV slings

Bone-anchored graft slingse.g. In-Fast Ultra™

Tension-free biologic slings

TO Subfascial HammockTVT-O

Chirurgia della IUS: Percorso Storico

Single incision Single incision slingsling

Minisling:Vantaggi

Ridotto rischio sanguinamento

Possibilità di riposizionamento

Ridotto dolore post-operatorio

Possibilità anestesia locale

Ridotto decorso post-operatorio

Sistema rilascio performante

Sicurezza nel tensionamento

Ridotta Incisione

Autor/Pub n F/U Risultati/Cura

Oliviera et alEAU 2010

90 (30

MiniArc, 30 TVT-

O, 30 TVT-S)

12 mesi Multicentrico

93% CuraMiniArc 87% guarite, 6% migliorateTVT-O 83% guarite, 10% migliorateTVT-S 67% guarite, 13% migliorate

Moore et alGynecology

Surgical Tech Int’l XVIII

61 12 mesiRetrospettivoMulticentrico

91.4%Oggiettivo e soggettivo(Stress test – questionario pazienti)

Minarc

Autor/Pub n F/U Resultati/CuraPickens et al

AUA 2009120 13 mesi

MulticentricoProspettivo

94% guarite (definito come 0 pad))

De Ridder et alInt Urogynecol J

Mar 2010

131 (75 MiniArc

, 56 Monarc

)

12 mesi MulticentricoRetrospettivo

85% MiniArc stress test negativo89% Monarc stress test negativo

Minarc

n F/U Resultati/Cura143 2 anni

MulticentricoProspettico

84,5% cough stress test negativo80,1% 1-hr Pad Test (gm) ≤ 1 gram 92,9 soggettivo

Risultati a 4 anni e anestesia locale

n F/U Resultati/Cura135 4 anni

In anestesia locale

86,7% stress test negativo85,7 soggettivo

Tutti i casi effettuati in anestesia locale

J Urol. 2014 Jun 5

The Safety and Efficacy of a New Adjustable Single Incision Sling for Treatment of Female Stress Urinary Incontinence Through 12 Months of Followup.

Kocjancic E1, Tu LM2, Erickson T3, Gheiler E4, Van Drie D5.

Of 116 surgical attempts 113 subjects were implanted with the Altis sling. Of these patients 103 had primary efficacy data at baseline and 6 months, and 101 had efficacy data at baseline and 12 months. Consequently 88 (85.4%) subjects at 6 months and 91 (90.1%) at 12 months achieved a 50% or greater reduction in pad weight. The cough stress test was negative for 95 (92.2%) subjects at 6 months and 91 (90.1%) at 12 months. A decrease in median leaks per day was observed at 6 months and improvements in all patient reported measures were observed through 12 months. A majority of subjects reported feeling much better or very much better at 6 and 12 months, respectively. There were no reports of mesh erosion or migration and no unanticipated adverse events through 12 months.

Altis

METHODS:In this prospective observational study, a total of 52 women with SUI were implanted with an Altis sling in an ambulatory setting. Before and after intervention (3, 6, and 12 months), women completed the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). In addition, patients underwent a cough stress test at each evaluation and a post-voiding residual urine volume estimation at 3 monthsPatients were excluded if they had POP of stage >2 previous failed sling surgery and OAB symptoms

RESULTS:The subjective cure rate at 12 months was 84.0%, with an additional improvement rate of 8.0%. The objective cure rate was 90.2%. Later postoperative complications included 1 case of vaginal extrusion (requiring surgical removal of the eroded mesh segment), 3 cases of vaginal exposure of the adjustment thread (managed conservatively), de novo urgency in 3 patients, and mild dyspareunia in 2 patients.

Authors No patients Mean F-up (Months)

Efficacy objective %

Efficacy subjective %(1 ou 2 PGII)

F. Haab et al. 97 16 ± 5 86% NA

M. Abdel Fattah et al. 85 12 82% 80%

G. Naumann et al. 52 12 86% NA

M. Meschia,R Baccichet et al. 102 6 91% 86%

R. Assassa et al. 113 12 97% NA

AJUST® Sling – Consistent outcomes

AJUST® Sling – Shorter Return to the normal activity / work

The AJUSTThe AJUSTTM TM system: system: an innovative treatment for incontinencean innovative treatment for incontinence

The Italian experienceThe Italian experience

On behalf of the Italian study group: On behalf of the Italian study group: Magenta ( M.Meschia ), Montecchio Emilia ( L Spreafico ) , Treviso (R Baccichet )Magenta ( M.Meschia ), Montecchio Emilia ( L Spreafico ) , Treviso (R Baccichet )Pieve di Coirano ( M. Mafiolini ) , Milano ( P. Piffarotti )Pieve di Coirano ( M. Mafiolini ) , Milano ( P. Piffarotti )

Interim analysis of 105 women at 3 and 6 months follow-Interim analysis of 105 women at 3 and 6 months follow-upup

Cure ratesCure rates Women without SUI symptoms Negative stress test Subject. and object.

90/105 (85.7%)96/105 (91.4%)87/105 (82.9%)

ICIQ-SF (mean + SD) 3.2 + 4.6*

W-IPSS (mean + SD) 4.5 + 5.2*

PGI-I (mean + SD)

ComplicationsComplications Voiding difficulty Urinary tract infection “De novo” OAB symptoms [dry / wet] Anchor detach./dyspareunia New surgery

1.5 + 0.9

4 (3.8%)8 (7.6%)

9 (8.6%) [5(4.8%) / 4(3.8%)]15

(3 for SUI;1 for POP;1 for anchor removal )

* p < .001 when compared with pre-operative data

TASSO DI COMPLICANZE SOVRAPPONBILE…..SE NON INFERIORE

NESSUNA COMPLICANZA MAGGIORE

POSSIBILITA’ DI REGOLARE IL TENSIONAMENTO ….. E DI RIPOSIZIONARE LA SLING

CURVA DI APPRENDIMENTO SUFFICIENTEMENTE RAPIDA

TASSO DI SUCCESSO SOVRAPPONIBILE

SIGNIFICATIVA RIDUZIONE DELL’INVASIVITA’ CHIRURGICA

Quali i PRO

Grazie.

SLING AD INCISIONE SINGOLA