Stress urinary incontinence surgery with MiniArc® sling system: Our experience

Abstract Objectives The objective of this article is to describe, retrospectively, the surgical technique for placing the AMS MiniArc ® sling system used for the treatment of urinary incontinence, and evaluate its results and complications. Material and method We present a retrospective study about the placement of the AMS MiniArc ® tape sling system. From August 2007 to March 2009, we placed the tape in a hammock position in 135 patients, 110 (81.5%) of whom had stress urinary incontinence, and 25 (18.5%) mixed incontinence. The patients’ median age was 55 years (range: 27–82 years). All the procedures were performed with local anesthesia and as ambulatory major surgery. The patients were followed up in the outpatient clinic at one month (check-up 1), between 3 and 6 months (check-up 2), and at one year (check-up 3). The clinical history and physical examination were done, and the ICIQ-SF was given, to which we added one question to evaluate satisfaction. A negative stress test with full bladder performed at the office during the physical examination was considered objective cure. The results analysis, descriptive analysis, and means comparison with Student's t-test were done with the SPSS program (V 14.0). Results Median follow-up was 495 days (range: 181–777 days). Among the 135 operated patients, the intraoperative complications were two bladder perforations. Early complications included one case of hematoma in the obturator fossa which resolved spontaneously, and four cases (2.9%) with mild, non-incapacitating, inguinal pain. The late complications included four cases (2.9%) of mesh extrusion, and three (2.2%) who required the unilateral cutting of the mesh due to obstruction. In nine patients (6.6%) there was a de novo urgency, five of which (3.7%) were temporary (2–6 months), and four (2.96%) were persistent and treated with anticholinergics. At one year, 91.9% of patients were cured. Of the patients with mixed incontinence, 88% were cured, as were 92.7% of those with stress incontinence. The ICIQ-SF and the question about satisfaction showed a mean decrease of 12.7 points, with 90% of patients very satisfied or quite satisfied. Conclusion The AMS MiniArc ® sling system is one more surgical tool to treat urinary incontinence; the main advantage over its predecessors is the possibility of operating with local anesthesia, which permits to adjust the sling's tension in situ. However, further studies are required in order to demonstrate long-term results compared to the gold standard TVT