Objectives
The MiniArc sling system has been used to treat female stress urinary incontinence (SUI) in our hospital since July 2014. It is comparatively less invasive and has been reported to reduce the risk of complications such as bladder perforation, injuries to structures in the true pelvis and groin pain. Placement techniques of the sling varied between institutions without a consensus as to the best method of placement. This was until the IUGA Conference in June 2015 where a 4-step technique was introduced by Astora Women’s Health (AWH). Outcome data for this new technique is still scarce. We report our experience and 2-year outcomes.
Methods
Forty-one patients underwent a MiniArc sling system surgery in our hospital from 18 June to 30 November 2015 by a single operator using the 4-step technique from AWH. This involves advancing the trocar tip into the endopelvic fascia, rotating the tip 45 degree aiming for the superior medial aspect of the obturator foramen and penetrating into the obturator internus muscle to ensure a tighter hold and better tension. Case notes were reviewed to assess the demographics, preoperative urodynamic evaluation, operative details, complications and outcomes.
Results
Mean age and parity of the 41 patients were 59.5±8.3 years and 2.9±1.4 children respectively. 73.2% patients were postmenopausal. Pre-operative urodynamic studies showed mean urodynamic stress incontinence of 26.2g±50.1. Mean duration and estimated blood loss were 23.4 minutes and 3.4ml respectively. Intraoperative bladder perforation rate was 7.3% (n=3/41), of which one patient had failed MiniArc sling insertion and was converted to TVT-abbrevo insertion. Postoperative complication rate was 9.8% with two patients having superficial wound infection related to concomitant abdominal surgery and two patients who failed trial-off-catheter for a total of 12 and 19 days each. Rate of voiding difficulties more than 7 days was 22%. 32 patients came back for 2 years post-surgery while 5 are due for their follow-up appointment next month. 4 patients were lost to follow-up. Cure rate at 2 years was 96.9%. Rates of mesh extrusion (out to vaginal wall) and dyspareunia were 3.1% (n=1/32) and 3.1% (n=1/32) respectively.
Conclusion
Our experience shows that the MiniArc sling system surgery is a safe and effective treatment for female SUI with a high 2-year cure rate of 96.9%. Rates of mesh extrusion and dyspareunia were low in our population. While there were cases of intraoperative and postoperative complications, no long term adverse outcomes arose from them.