الفهرس 
Anatomy of Lower Urinary Tract
The mucosa of the bladderOnly 14 pages are availabe for public view
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Abstract
Stress urinary incontinence (SUI) is the predominant
type of incontinence affecting approximately 50% of
incontinent women. SUI reduces quality of life , causes
important social limitations and represents an important
economic burden (Hunskaar et al., 2004).
According to the International continence society, stress
urinary incontinence is defined as “A condition in which
involuntary loss of urine on effort or exertion, or on sneezing
or coughing” (Abrams et al., 2003).
Midurethral slings have revolutionized the surgical
management of stress urinary incontinence in women and
several procedures for midurethral slings have been reported
(Papatsoris et al., 2007).
Tension-free vaginal tape (TVT) can stabilize the
urethra during straining without modifying urethral mobility
(Petros and Richardson, 2005). TVT creates a neopubourethal
ligament that anchors the three muscle forces activating
urethrovesical closure, including pubococcygeus muscles, longitudinal muscle of the anus and levator plate (Sekiguchi et
al., 2009).
Recognized complications of retropubic mid-urethral
slings include voiding dysfunction and the potential for bowel,
bladder, and vascular injuries (Ogah et al., 2011).
In 2001, Delorm e described a new method of inserting
the tape, which passes through the obturator foramen (termed
transobturator tape [TOT]), thus theoretically avoiding some of
the complications such as bladder perforation (Petros and
Richardson, 2010).
Clinical trials have demonstrated that transobuturator
slings are associated with equivalent subjective cure rates to
retropubic slings, with less voiding dysfunction and fewer
bladder perforations (Novara et al., 2010). However,
transobturator slings have lower objective cure rates and have
greater risk of postoperative neurologic symptoms in the
obturator region (Richter et al., 2010).
To maintain efficacy and patient satisfaction while
avoiding such complications, minimally invasive mini-slings
have been developed (Neuman, 2007). Mini-slings often are
performed as an outpatient surgery, with minimal morbidity,
pain, and quick patient recovery (Kennelly and Myers, 2011).Single-incision sling procedure for SUI is meant to be
less invasive by avoiding the blind trocar passage through the
retropubic or transobturator spaces associated with standard
midurethral slings. As such, it has the potential for fewer
complications, less postoperative pain, and decreased
anesthesia requirements than standard slings. This device can
be placed using a retropubic or “U” approach, or a
transobturator-like “hammock” approach. Clinical trials
evaluating single-incision mini-slings are limited, but one
study found similar cure rates between the “U” and hammock
approaches with objective and subjective cure rates of 84%
and 76%, respectively; however, quality of life and treatment
satisfaction favored the “U“ approach (Lee et al.,2010).
The aim of the current study is to compare the efficacy
and safety of retropubic single incision minisling with tension
free vaginal tape in the treatment of female stress urinary
incontinence.
This study was conducted in of Ain Shams University
Maternity Hospital and included 48 patients with stress urinary
incontinence who were recruited from the urogynecologic
outpatient clinic. Patients were randomized to receive either
minisling or TVT In this study there was no statistically significant
difference between retropubic minisling and TVT groups
regarding age, body mass index, parity and menopausal status.
Also, preoperative evaluation including urethral
hypermobility, PFDI-20 and PISQ-12 questionnaires and
incontinence severity index and urodynamic study including
maximum bladder capacity, cough leak point pressure, resting
urethral closure pressure and maximum urinary flow rate
showed no significant difference between minisling and TVT
groups.
In the current study, operative time was significantly
shorter in retropubic minisling group as compared to TVT
group. Also, estimated blood loss in retropubic minisling
group was significantly less than TVT group. Postoperative
data showed a significantly less visual analogue scale in
minisling versus TVT group while duration of hospital stay
was comparable between both groups.
In this study there was no statistically significant
difference between retropubic minisling and TVT groups
regarding objective cure rate (negative stress test), subjective
cure rate, PFDI-20, PISQ-12 and patient global index of
improvement. As regards complications, there was significantly lower
incidence of immediate and short term complications in the
retropubic minisling group than in TVT group while the
incidence of long term complications was comparable between
groups.
The present study showed that there was no significant
difference between retropubic minisling and TVT groups
regarding follow up urodynamics study at 1 year including
cystometry maximum bladder capacity, resting urethral closure
pressure and maximum flow rate. Urodynamics study
parameters did not change significantly from preoperative
values in both groups except for resting urethral closure
pressure which was significantly higher due to correction of
urethral hypermobility.