31 Mar Stress Urinary Incontinence in Women: Study Evaluates Single-Incision Mini-Slings
MedicalResearch.com Interview with:
Professor Mohamed Abdel-Fattah, MD, FRCOG
Chair in Gynaecology
Consultant Gynaecologist & Sub-specialist Urogynaecologist
School Medicine, Medical Sciences and Nutrition
University Of Aberdeen
Co-Director Aberdeen Centre For Women’s Health Research
Lead – MBChB intercalated degree programme
Chief Investigator – CATHETER II, FUTURE, and SIMS RCTs
MedicalResearch.com: Why was this study necessary?
Response:At the time of study design, the main surgical option for treating stress urinary incontinence was the insertion of a standard mid-urethral sling, usually using a general anaesthetic. However, single incision mini-slings were introduced to clinical practice without robust assessment. They were considered promising due to several potential advantages including using less mesh more possibility to be performed under local anaesthetic.
A number of small studies with short-term follow-up (i.e. low quality evidence) showed mini-slings to have similar success rates to standard mid-urethral slings, but required shorter hospital stay and was less painful immediately after surgery. Several systematic reviews at the time recommended an adequately powered robust randomised trial to compare the clinical and cost-effectiveness of mini-slings to standard mid-urethral slings with adequate term follow-up.
MedicalResearch.com: What are the main findings?
Response: The main findings of this study are “the patient-reported success rates of adjustable anchored minislings at 3 years follow-up are non-inferior to standard tension-free mid-urethral slings”. Most women in both groups reported their incontinence symptoms were very much/much improved. Women allocated to both groups reported similar success rates for quality of life and sexual function. Women who received mini-slings reported slightly more mesh exposures and were more likely to report pain during intercourse (dyspareunia). Groin/thigh pain rates were almost similar between groups.
MedicalResearch.com: What should readers take away from your report?
Response: The choice of which surgery to undergo for quality of life issues such as SUI, should be made by women after considering the best available evidence for the potential benefits and adverse events of each surgical option and alternative non-surgical options. The results of the SIMS RCT will help women considering SUI surgery making an informed choice for which surgery to choose.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response:Long-term outcomes of continence procedures are essential if we are to establish the safety and longevity of the procedures. Follow-up for 10 years post surgery are underway for the SIMS RCT participants.
Single-Incision Mini-Slings for Stress Urinary Incontinence in Women
Mohamed Abdel-Fattah, M.D., David Cooper, Ph.D., Tracey Davidson, M.Sc., Mary Kilonzo, M.Sc., Md Hossain, Ph.D., Dwayne Boyers, Ph.D., Kiron Bhal, M.D., Judith Wardle, Ph.D., James N’Dow, F.R.C.S.(Urol.), Graeme MacLennan, M.Sc., and John Norrie, M.Sc.
March 31, 2022
N Engl J Med 2022; 386:1230-1243
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