Objective: To evaluate the ultrasound morphology and its clinical outcome among women who had undergone MiniarcTM vs MonarcTM in the treatment of stress urinary incontinence (SUI), 5-year review.
Study Design: This is a 5-year review study from a previous reported prospective study on 147 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were studied.
Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-hour pad test of <2 g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at 3-years explored the sling and bladder neck’s position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking.
Results: Postoperative data was available from 138 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 123 women (51 Monarc, 72 Miniarc) at 3rd year, the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and no exposure noted in both groups. At 3rd year, rest and during Valsalva, analogous distances of the bladder neck and sling as well as TU (distance between the mid position of the sling and center of urethral core) were similar for both procedures. In both groups, US (urethral shortest diameter) and Ul (urethral longest diameter) were comparable at Valsalva that was significantly shorter and longer respectively compared to the values at rest. Both slings demonstrated caudally shift in the x-axis and y-axis. Miniarc position shifted more caudally on the x-axis (xt) at rest with concomitant more caudally shift on the y-axis on straining than Monarc. Percentage of urethral kinking remained similar. Failure rate increased with Miniarc but statistical analysis failed to detect any significant difference between the 2 groups with regards to the objective and subjective cure (Miniarc 87.8% and 82.9% vs Monarc 91.1% and 89.3%; p>0.05).
Conclusions: In conclusion, Miniarc and Monarc maintained comparable subjective and objective clinical outcomes at 3-years minimum follow-up. Ultrasonography evaluation revealed more shift in the position of Miniarc caudally on x-axis at rest and y-axis during straining compared to Monarc. Majority of urethral impingement was still noted in the Miniarc group with concurrent higher MUCP (maximum urethral closure pressure). The differing shift may be related to sling anchoring mechanism.
Keywords: Anti-incontinence surgery, mid-urethral slings, outcomes, single incision sling, ultrasonography