Ajust single incision transobturator sling procedure for stress urinary incontinence: results after 1-year follow-up
ABSTRACT Data on the Ajust, a new single-incision sling procedure for female stress urinary incontinence (SUI) management, remain scarce and limited to a 1-year follow-up. Our goal was to assess the efficacy of this procedure after a 1-year follow-up.
This prospective evaluation involved 95 consecutive patients implanted with Ajust at a single centre. All patients had SUI on urodynamics due to urethral hypermobility, 33 % had preoperative overactive bladder (OAB) symptoms and none had detrusor overactivity. Ninety-two patients were treated on an outpatient basis, and 3 patients had general anaesthesia. Postoperative assessment was conducted at 1, 6, 12 months, and yearly thereafter. The main outcome measure was pad usage. Secondary parameters were self-reported SUI episodes, OAB symptoms, data of clinical examination, satisfaction using the Patient Global Impression of Improvement (PGI-I) scale, postoperative pain, and adverse events.
After a mean follow-up of 21 ± 6 months (12-32), 76 out of 95 patients used no pads or one dry security pad, showing a success rate of 80 %. Seventy-nine out of 95 patients had no more SUI-related leakage. Only 6 patients experienced late recurrence of SUI after 6 months' follow-up. Perioperative complications included 1 case of vaginal hematoma, 1 case of acute urinary retention, 2 cases of urinary tract infection, all managed conservatively. Half of the patients had no pain after day 1, free of medications. Late complications were vaginal erosion in 1 case, and pain during exertion in 2 cases.
The Ajust single incision transobturator sling is a safe and effective procedure, with durable results after 1 year.
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ABSTRACT: The primary outcome of this study was to evaluate the subjective and objective outcomes of an adjustable Single Incision Sling (Ajust™ C.R. Bard Inc., New Providence, NJ, USA) for the treatment of SUI, with a 2-year follow-up. The secondary outcome was to evaluate the safety of this procedure and the impact of this mini-sling on the filling and voiding phases of the bladder.European Journal of Obstetrics & Gynecology and Reproductive Biology 08/2014; 182C:48-52. DOI:10.1016/j.ejogrb.2014.08.011 · 1.63 Impact Factor
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ABSTRACT: PURPOSE: We analyzed the correlation between pad usage as determined by objective pad count and the severity of urinary incontinence as measured by pad weight. MATERIALS AND METHODS: This is a retrospective study of consecutive incontinent patients who wore pads on a daily basis and were instructed to complete a 24-hour pad test. They were told to use their usual pads, change them as they usually do and place each in a separate plastic bag the day before their scheduled appointment. All pads were weighed and total urine loss was calculated by subtracting the dry pad weight from the wet pad weight assuming that 1 gram of weight increase is equivalent to 1 ml of urine loss. The number of pads was correlated to the pad weight using Spearman's rank correlation coefficient due to the non-parametric nature of the data. RESULTS: There were 116 patients comprised of 51 men (age range 39-89, mean 66) and 65 women (age range 27-95, mean 72). The Spearman's rho comparing the number of pads used to grams of urine loss was 0.26 (p=0.005) for the total cohort and 0.40 (p<0.05) and 0.26 (p<0.05) for males and females, respectively. CONCLUSION: There was little correlation between number of pads used and severity of urinary incontinence (r = 0.26). This data suggests that pad counts should not be used as an objective measure of incontinence severity and that instead, pad weight on a 24 hour pad test should be utilized.The Journal of urology 05/2013; 190(5). DOI:10.1016/j.juro.2013.05.055 · 3.75 Impact Factor
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ABSTRACT: To assess the efficacy and complications of inside-out transobturator tension-free vaginal tape (TVT-O) in comparison with a single incision sling procedure (Ajust) for the treatment of urodynamic stress urinary incontinence. Prospective closely matched controlled study. In total, 171 patients were included in the study: 86 women underwent the TVT-O procedure, while in other 85 cases the Ajust procedure was performed. Subjective and objective cure, improvement and failure rates, mean operative time, hospital stay and incidence of complications were assessed. There was no statistically significant difference between the two groups for age, body mass index, parity, menopausal status and severity of prolapse. No major intraoperative complications occurred. There was no significant difference in the mean operative time and the duration of hospital stay between the two groups. The mean follow-up time of the study was 22.3 months (range 12-36 months). For the TVT-O group the objective cure rate was 86%, the improvement rate was 5.9% and the failure rate was 8.1%, while the subjective cure rate was 82.6%. For the Ajust group the objective cure rate was 84.7%, the improvement rate was 4.7%, 10.6% of patients showed no change in their symptoms and the subjective cure rate was 81.2%. The Ajust sling procedure presents success rates, at 22 months' mean follow up, comparable to the TVT-O method. Both techniques seem to be safe and effective for the treatment of urodynamic stress urinary incontinence.European journal of obstetrics, gynecology, and reproductive biology 08/2013; 170(2). DOI:10.1016/j.ejogrb.2013.07.041 · 1.63 Impact Factor