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Retropubiskt eller transobturatoriskt? Vad styr valet av operationsmetod? • Transvaginala metoders fördelning på landets kliniker (Anders Kjaeldgaard) • TVT håller fortfarande måttet! Jämförelse av registerdata på TVT, TVT-O och TOT (Maud Ankardal) • TOT eller TVT eller båda (Tomas Winberg) • TVT, ofta med ett O (Fatimeh Taheri-Johansson) Transvaginala metoder: Fördelning på olika sjukhus 2009 sjukhus TVT IVS TVT-O TOT TVTsecure antal pat Jönköp % 94,7% ,0% 5,3% ,0% ,0% 94 Eksjö % 60,7% ,0% ,0% 39,3% ,0% 28 Vmo % 20,0% ,0% 80,0% ,0% ,0% 20 SU/SÖ % 85,3% 1,1% 9,6% 3,4% ,6% 177 823 8 437 197 16 1481 55,6% ,5% 29,5% 13,3% 1,1% 100,0% Riket Pat antal % Behandlingsresultat 2009 Urinläckage, Uppf 8 v (ver 3.0) sjukhus Aldrig Nästan aldri g 1-3 ggr/ mån 1-3 ggr/ veck a Dagl igen Uppgift sakn as antal pat Jönköp % 46,7% 24,0% ,0% 13,3% 13,3% 2,7% 75 Eksjö % 51,9% 40,7% 3,7% ,0% 3,7% ,0% 27 Vmo % 47,4% 31,6% 5,3% 5,3% 10,5% ,0% 19 SU/SÖ % 53,0% 20,1% 5,2% 9,7% 11,9% ,0% 134 526 359 59 96 161 12 1213 43,4% 29,6% 4,9% 7,9% 13,3% 1,0% 100,0% n Riket % Risk factors for suboptimal outcome Am J Obstet Gynecol. 2008 Dec;199(6):666.e1-7. Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings. Barber MD, Kleeman S, Karram MM, Paraiso MF, Ellerkmann M, Vasavada S, Walters MD. Department of Obstetrics and Gynecology and Glickman Urological Institute, Cleveland Clinic, Cincinnati, OH, USA. Study design • • • Clinical studies on TVT and TOT. UI and uterovaginal prolapse included Follow-up: 1 year Outcome: any recurrent UI or SUI Results • • • concomittant prolapse surgery anticholinergics age Retrospective study I TOT vs. TVT Acta Obstet Gynecol Scand. 2009;88(8):920-6. Which type of mid-urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension-free vaginal tape or transobturator tape. Gungorduk K, Celebi I, Ark C, Celikkol O, Yildirim G. Department of Obstetrics and Gynecology, Istanbul Bakirkoy Women and Childrens' Hospital, Istanbul, Turkey. [email protected] Study design • • retrospective follow-up: mean 2½ years Material • • n=300 primary slingoperations as sole procedure, only SUI TVT=180, TOT=120 Results • Cure rates: TVT 78%, TOT 52,5% p<0.00001 Retrospective study II TOT vs. TVT Am J Obstet Gynecol. 2008 Jul;199(1):76.e1-4. Epub 2008 Jan 25. Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency. Jeon MJ, Jung HJ, Chung SM, Kim SK, Bai SW. Department of Obstetrics and Gynecology, Yonsei University Health System, Seoul, Korea. Study design • • retrospective follow-up: 2 years & 7years Material • n=253 (PVS=87, TVT=94, TOT=72) Results • • cure rates 2yy: PVS=87%, TVT=87%, TOT=35% cure rates 7yy: PVS=59%, TVT=55%, TOT= ? p<0.0001 ns Evidence-based medicine BJOG. 2007 May;114(5):522-31. Epub 2007 Mar 16. Review. Erratum in: BJOG. 2007 Oct;114(10):1311. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. Latthe PM, Foon R, Toozs-Hobson P. Department of Obstetrics & Gynaecology, Birmingham Women's Health Care NHS Trust, Birmingham, UK. [email protected] Material • • :TOT vs. TVT: Only 5 RCTs included TVTO vs. TVT: Only 6 RCTs included Results • Cure rates: No difference between retropubic and transobtorator methods Complications • TVT has more bladderperforations • TOs have more erosions and groin pain Risk factors for suboptimal outcome of transvaginal sling Summary of literature • • • • concomittant prolapse surgery anticholinergics (urge incontinence) age intrinsic sphincter deficiency (transobturator methods less suitable?)