Comparative analysis of the effectiveness of surgical treatment of stress urinary incontinence using synthetic implants or own vaginal tissues

Kira K.E.

Relevance/aims of study. The problem of urinary incontinence is one of the leading factors in reducing the quality of life in women during pre- and postmenopausal periods and sometimes in women of childbearing age. The aim of this study is to compare the effectiveness of two anti-stress technics: sling operation using a synthetic implant and the method of sub-pubic uretrovesicopexy with a vaginal flap (UVVF).

Study design, materials and methods. During the period from 2011 to 2018, 105 patients with urinary incontinence were examined and surgically treated. 2 groups have been formed: 1 group — 52 patients who performed operation TVT-O, 2 group — 52 patients who performed operation of sub-pubic uretrovesicopexy with vaginal flap.

Results. The operation with synthetic implant is technically simpler, faster and less blood loss than using a vaginal flap. At the same time, in the first group, the risk of injury to adjacent organs may be higher. Relapses of urinary incontinence in the distant period occurred in 7 (13.4%) and 9 (17%) patients, respectively, in the 1st and 2nd groups. In group 1, one year later, relapse occurred in 2 (3.8%) patients (p = 0.57, Fisher ‘s exact criteria) and 5 years later in 5 (9.6%). In the 2nd group, these indicators were 3 (5.7%) and 6 (11.3%) patients, respectively. Of the 105 patients, urine was retained 1 year after surgery by 100 (95.2%) women, and 94 (89.5%) 5 years after surgery. In both groups, 89 (84.8%) patients had effective treatment.

Conclusion. Obturator approach by TVT-O surgery is an anatomically reasonable method of treating SUI. Sub-pubic urethrovesicopexy with vaginal flap in treatment of SUI is anatomically and functionally justified due to certain stages. TVT-O and sub-pubic uretrovesicopexy with vaginal flap are equally effective (p > 0.05) in surgical treatment of SUI in women both in the near postoperative (96.2% and 94.3% respectively) and in the distant period (90.4% and 88.7% respectively).

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