The MiniArc Sling System for the Treatment of Female Stress Urinary Incontinence - A Comparison of Techniques

Ang J1, Han H1, Huang E1

Research Type

Pure and Applied Science / Translational

Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 383
Open Discussion ePosters
Scientific Open Discussion Session 21
Thursday 30th August 2018
13:45 - 13:50 (ePoster Station 7)
Exhibition Hall
Female Stress Urinary Incontinence Urodynamics Techniques
1. KK Women's & Children's Hospital
Presenter
E

Eugene Huang

Links

Poster

Abstract

Hypothesis / aims of study
The MiniArc 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 (1).  Placement techniques of the sling vary without consensus on the best method until the IUGA Conference in June 2015 where a 4-step technique (2) was introduced by Astora Women's Health (AWH). Outcome data and technique comparisons are still scarce. We report our experience and two year outcomes with the MiniArc sling system.
Study design, materials and methods
A single operator performed all MiniArc surgeries in our hospital. A total of 87 patients underwent MiniArc surgery from 3rd July 2014 to 30th November 2015 for SUI. 46 patients underwent surgery from 3rd July 2014 to 4th June 2015 (Group A). 41 patients underwent surgery with the AWH technique from 18th June 2015 to 30th November 2015 (Group B). Data was collected on for demographics, preoperative and postoperative urodynamic evaluation, operative details, complications and outcomes.

Surgical Techniques
Group A – The initial technique entails inserting the needle and aiming towards the medial edge of the obturator foramen approximately 45 degrees off the horizontal plane. Once beyond the ischiopubic ramus, the handle is pivoted and tip advanced into the obturator internus muscle. (2)
Group B – The AWH technique entails advancing the trocar tip into the endopelvic fascia at 30 degrees from the midline, drifting the trocar shaft 0.5cm cephalad to arc around the rami, rotating the tip 45 degrees aiming for the superior aspect of the obturator foramen and penetrating into the obturator internus muscle. (3)

The difference between the two techniques include the angle of insertion and presence of cephalad drift.
Results
Table 1 summarises the baseline demographic data. The two groups were similar in age, parity, menopausal status and BMI. Preoperative urodynamic studies showed Group A patients had worse SUI than Group B patients (mean leakage: 56.1g±95.6 vs 12.4g±33.4, p=0.037). MiniArc surgery duration was shorter in Group A (13.4min±4.8 vs 23.4min±14.7, p=0.01). The estimated blood loss was similar (3.4ml±2.2 vs 6.0ml±6.0). Similar rates of bladder perforation and urinary tract infection were noted. Postoperative complications were similar between the groups and included two patients with superficial wound infection related to concomitant abdominal surgery from Group B. Rate of voiding difficulties more than 7 days requiring catheterisation was similar at approximately 9% in both groups. One patient from Group A required tape cutting at the 20th postoperative day. Mean duration of catherization was similar between the groups at 3.1±7.0 days, with a range of 0-53 days in Group A and 0-19 days in Group B. 

38 patients from Group A (82.6%) and 34 patients from Group B (82.9%) were followed up at two years. Cure rates were 81.6% vs 97.1% in Groups A and B respectively but were not statistically significant (p=0.063). Rates of vaginal mesh extrusion and dyspareunia were also not statistically significant at 2.9% in Group B and no reported cases in Group A (p=0.457).
Interpretation of results
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. Rates of postoperative complications such as failed trial-off-catheter may be related to the better tension and hold of the MiniArc system with the new technique. Higher rates of bladder perforation in Group B may be related to the cephalad drift of the handle prior to insertion. Rates of mesh extrusion and dyspareunia were low in our population.
Concluding message
While the production of the MiniArc sling system has been ceased, there may still be a role in single incision mini-slings.
Figure 1
Figure 2
References
  1. A Gauruder-Burmester, G Popken. The Miniarc Sling System in the Treatment of Female Stress Urinary Incontinence. Int Braz J Urol. 35 (3): 334-343, June 2009
  2. Miniarc Single- incision sling system. Instructions for use. Product overview. American Medical Systems 2011
  3. Placing the MiniArc Single-Incision Sling System – Key Surgical Considerations. American Medical Systems. May 2015
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Singhealth Centralised Institutional Review Board Helsinki Yes Informed Consent No
28/03/2024 10:42:11