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Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc).
Eur J Obstet Gynecol Reprod Biol. 2014 Nov; 182:91-7.EJ

Abstract

OBJECTIVE

To evaluate the ultrasound morphology and its clinical outcome among women who had undergone Miniarc™ vs Monarc™ in the treatment of stress urinary incontinence (SUI).

STUDY DESIGN

This was a prospective study on 140 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were included in the study. Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-h pad test of <2 g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at one-year explored the sling and bladder neck's position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking.

RESULTS

Postoperative data was available from 130 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 119 women (46 Monarc, 73 Miniarc), the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and 15 cases (7.1% of Monarc and 16.3% of Miniarc, p=0.082) of urinary retention was reported due to over-tensioning of the sling, majority of cases came from the Miniarc group. At rest and during Valsalva, analogous distances of the bladder neck and sling as well as the center of the urethral core were similar for both procedures. In both groups, shortest (Us) and longest diameters (Ul) of the urethral core were comparable at Valsalva which was significantly shorter and longer, respectively, compared to the values at rest. Sling position and percentage of urethral kinking were similar. Statistical analysis failed to detect any significant difference between the two groups with regards to the objective and subjective cure (p>0.05).

CONCLUSIONS

In conclusion, a Miniarc and Monarc exhibit similar mechanism of action with comparable subjective and objective clinical outcomes. Majority of urethral impingement was noted in the Miniarc group. A higher maximum urethral closure pressure (MUCP), longer resting Ul, and shorter resting Us suggested these observations. Postoperative ultrasonographic evaluation may give a promising future perspective for the evaluation of sling tension.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC. Electronic address: 2378@cgmh.org.tw.Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Sarawak General Hospital & Kuching Specialist Hospital (KPJ), Kuching, Sarawak, Malaysia.Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC.Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, De La Salle University Medical Center, Dasmariñas, Cavite, Philippines.Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Hospital Serdang, Kajang, Selangor, Malaysia.Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, King Abdullah University Hospital/University of Science & Technology, Irbid, Jordan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25265496

Citation

Lo, Tsia-Shu, et al. "Ultrasonography and Clinical Outcomes Following Surgical Anti-incontinence Procedures (Monarc Vs Miniarc)." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 182, 2014, pp. 91-7.
Lo TS, Tan YL, Wu PY, et al. Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). Eur J Obstet Gynecol Reprod Biol. 2014;182:91-7.
Lo, T. S., Tan, Y. L., Wu, P. Y., Cortes, E. F., Pue, L. B., & Al-Kharabsheh, A. (2014). Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). European Journal of Obstetrics, Gynecology, and Reproductive Biology, 182, 91-7. https://doi.org/10.1016/j.ejogrb.2014.09.015
Lo TS, et al. Ultrasonography and Clinical Outcomes Following Surgical Anti-incontinence Procedures (Monarc Vs Miniarc). Eur J Obstet Gynecol Reprod Biol. 2014;182:91-7. PubMed PMID: 25265496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). AU - Lo,Tsia-Shu, AU - Tan,Yiap Loong, AU - Wu,Pei-Ying, AU - Cortes,Eileen Feliz M, AU - Pue,Leng Boi, AU - Al-Kharabsheh,Ahlam, Y1 - 2014/09/16/ PY - 2014/05/16/received PY - 2014/08/22/revised PY - 2014/09/03/accepted PY - 2014/9/30/entrez PY - 2014/9/30/pubmed PY - 2015/11/3/medline KW - Anti-incontinence surgery KW - Mid-urethral slings KW - Outcomes KW - Single incision sling KW - Ultrasonography SP - 91 EP - 7 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur J Obstet Gynecol Reprod Biol VL - 182 N2 - OBJECTIVE: To evaluate the ultrasound morphology and its clinical outcome among women who had undergone Miniarc™ vs Monarc™ in the treatment of stress urinary incontinence (SUI). STUDY DESIGN: This was a prospective study on 140 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were included in the study. Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-h pad test of <2 g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at one-year explored the sling and bladder neck's position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking. RESULTS: Postoperative data was available from 130 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 119 women (46 Monarc, 73 Miniarc), the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and 15 cases (7.1% of Monarc and 16.3% of Miniarc, p=0.082) of urinary retention was reported due to over-tensioning of the sling, majority of cases came from the Miniarc group. At rest and during Valsalva, analogous distances of the bladder neck and sling as well as the center of the urethral core were similar for both procedures. In both groups, shortest (Us) and longest diameters (Ul) of the urethral core were comparable at Valsalva which was significantly shorter and longer, respectively, compared to the values at rest. Sling position and percentage of urethral kinking were similar. Statistical analysis failed to detect any significant difference between the two groups with regards to the objective and subjective cure (p>0.05). CONCLUSIONS: In conclusion, a Miniarc and Monarc exhibit similar mechanism of action with comparable subjective and objective clinical outcomes. Majority of urethral impingement was noted in the Miniarc group. A higher maximum urethral closure pressure (MUCP), longer resting Ul, and shorter resting Us suggested these observations. Postoperative ultrasonographic evaluation may give a promising future perspective for the evaluation of sling tension. SN - 1872-7654 UR - https://www.unboundmedicine.com/medline/citation/25265496/Ultrasonography_and_clinical_outcomes_following_surgical_anti_incontinence_procedures__Monarc_vs_Miniarc__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0301-2115(14)00484-9 DB - PRIME DP - Unbound Medicine ER -