JOURNAL OF FEMALE
Purpose: We prospectively compared transvaginal antimicrobial mesh (MycroMesh*) and anterior vaginal wall slings using an outcomes analysis.
Materials and Methods: Between August 1997 and November 1998 we implanted transvaginal slings in 40 consecutive women randomized to a synthetic mesh (20) or vaginal wall (20) group. All patients had documented stress urinary incontinence on preoperative urodynamics. We prospectively compared postoperative outcomes data obtained from pelvic examinations, cough stress test, cotton swab test and validated patient questionnaires using a visual analog scale.
Results: Complete followup was available in all patients. Mean followup was 22 months (range 12 to 27). Stress incontinence was cured in 95% of the mesh and 70% of the vaginal wall group, and pelvic prolapse was cured in 100% and 95%, respectively. Transient de novo urge incontinence was noted in 12.5% of the mesh and 14.3% of the vaginal wall group. Mean postoperative cotton swab angle during Valsalva`s Maneuver was 20 and 45 degrees for the mesh and vaginal wall groups, respectively. The incidence of urinary retention and tissue erosion was 0% for both groups. Te satisfaction rate was 100% and 80% for the mesh and vaginal wall groups, respectively.
Conclusions: The antimicrobial MycroMesh sling was superior to the vaginal wall sling for correction of stress incontinence and pelvic prolapse with comparatively low morbidity.
In this work, probably for the small casuistry, Choe et all didn't observe significant statistical difference in relation to the rates of cure of the stress urinary incontinence (SUI) or the morbidity to the comparative among the two differents techniques . In spite of this the authors ended that the MycroMesh it was superior results than the vaginal sling in the correction of SUI and with smaller morbidity. The obtained results (100% of cure) and without the main complications observed with it implants it of synthetic material (infection, erosion and extrusion) possibly they turn MycroMesh a good candidate for the use in patient carriers of SUI. The limitations of the work, however they should be clear:
1. small casuistry.
2. comparison with technique (vaginal sling ), with success indexes thankfully inferior to the one of the sling classic pubovaginal (at least in the hands of majority of the surgeon).
3. short following. Although most of the erosions and of the recidives of SUI it happens after an or two years of follow up, respectively, the erosions can happen up to 7 years after the placement of synthetic material and the indexes of success of the surgery tend to decrease with the postoperative following.
Aparecido Donizeti Agostinho
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