RESEARCH HIGHLIGHTS Nature Reviews Urology 12, 5 (2015); published online 11 November 2014; doi:10.1038/nrurol.2014.314
URINARY INCONTINENCE
Comparing AFS and TVT for stress urinary incontinence Not enough evidence exists to indicate a difference in outcomes between use of autologous fascial slings (AFS) and tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women, according to the long-term results of a study by Khan and colleagues. Many different procedures are available for treating SUI. No data exist to strongly support any of the methods over the others. Safety concerns have been raised about the placement of synthetic meshes for vaginal surgery, which Khan et al. say generates an argument for use of AFS. In their study, Khan and co-workers randomly assigned 201 women (aged >18 years) who required primary surgery for stress urinary incontinence to receive AFS (n = 79), TVT (n = 72) or a porcine dermis xenograft sling (n = 50) between 2001 and 2006. Patients were assessed by nurses using questionnaires at 6 weeks, 6 months and 12 months after surgery and their continence status was graded
as: ‘dry’, ‘improved’ or ‘wet’ (defined as either no better or as worse than before the operation). The researchers sent out further questionnaires by post in 2013, and attempted to contact nonresponders by telephone.
‘‘
…there is some evidence that ‘dry’ rates for AFS may be more durable than TVT…
’’
Khan et al. obtained follow-up data for 162 women with a median follow-up duration of 10 years (range 6.6–12.6 years). Recruitment to the xenograft sling arm of the trial was halted early owing to significantly poorer interim results. The primary outcome was surgical ‘success’, which was defined as the patient being completely dry or improved at the follow-up point. After 1 year, success rates were 93% for TVT, 90% for AFS and 61% for the xenograft sling. At 10 years, success rates were not significantly different
NATURE REVIEWS | UROLOGY
between the groups (73% for TVT, 75.4% for AFS and 58% for sling, respectively). A secondary outcome of dry rates showed that AFS was favourable to both TVT and to xenograft sling at 10 years (50.8% dry versus 31.7% and 15.7%, respectively). A deterioration in dry rates was seen in the TVT group between 1 year and 10 years, but dry rates remained stable in the AFS group and xenograft sling group. “In conclusion, from our present study we can conclude that there is not enough evidence to suggest a difference in longterm success rates between AFS and TVT in our hands...” say the authors. “However, there is some evidence that ‘dry’ rates for AFS may be more durable than TVT by per protocol analysis.” Rebecca Kelsey Original article Khan, Z. A. et al. Long-term follow-up of a multicentre randomised controlled trial comparing tensionfree vaginal tape, xenograft and autologous fascial slings for the treatment of stress urinary incontinence in women. BJU Int. doi:10.1111/bju.12851
VOLUME 12 | JANUARY 2015 © 2015 Macmillan Publishers Limited. All rights reserved
URINARY INCONTINENCE
Comparing AFS and TVT for stress urinary incontinence Not enough evidence exists to indicate a difference in outcomes between use of autologous fascial slings (AFS) and tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women, according to the long-term results of a study by Khan and colleagues. Many different procedures are available for treating SUI. No data exist to strongly support any of the methods over the others. Safety concerns have been raised about the placement of synthetic meshes for vaginal surgery, which Khan et al. say generates an argument for use of AFS. In their study, Khan and co-workers randomly assigned 201 women (aged >18 years) who required primary surgery for stress urinary incontinence to receive AFS (n = 79), TVT (n = 72) or a porcine dermis xenograft sling (n = 50) between 2001 and 2006. Patients were assessed by nurses using questionnaires at 6 weeks, 6 months and 12 months after surgery and their continence status was graded
as: ‘dry’, ‘improved’ or ‘wet’ (defined as either no better or as worse than before the operation). The researchers sent out further questionnaires by post in 2013, and attempted to contact nonresponders by telephone.
‘‘
…there is some evidence that ‘dry’ rates for AFS may be more durable than TVT…
’’
Khan et al. obtained follow-up data for 162 women with a median follow-up duration of 10 years (range 6.6–12.6 years). Recruitment to the xenograft sling arm of the trial was halted early owing to significantly poorer interim results. The primary outcome was surgical ‘success’, which was defined as the patient being completely dry or improved at the follow-up point. After 1 year, success rates were 93% for TVT, 90% for AFS and 61% for the xenograft sling. At 10 years, success rates were not significantly different
NATURE REVIEWS | UROLOGY
between the groups (73% for TVT, 75.4% for AFS and 58% for sling, respectively). A secondary outcome of dry rates showed that AFS was favourable to both TVT and to xenograft sling at 10 years (50.8% dry versus 31.7% and 15.7%, respectively). A deterioration in dry rates was seen in the TVT group between 1 year and 10 years, but dry rates remained stable in the AFS group and xenograft sling group. “In conclusion, from our present study we can conclude that there is not enough evidence to suggest a difference in longterm success rates between AFS and TVT in our hands...” say the authors. “However, there is some evidence that ‘dry’ rates for AFS may be more durable than TVT by per protocol analysis.” Rebecca Kelsey Original article Khan, Z. A. et al. Long-term follow-up of a multicentre randomised controlled trial comparing tensionfree vaginal tape, xenograft and autologous fascial slings for the treatment of stress urinary incontinence in women. BJU Int. doi:10.1111/bju.12851
VOLUME 12 | JANUARY 2015 © 2015 Macmillan Publishers Limited. All rights reserved
