title: Suburethral slingplasty evaluation study in North Queensland, Australia: the SUSPEND trial.
abstract: OBJECTIVE
  To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence.
  
  
  METHODS
  Following ethics approval, 195 (3 x 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. MAIN OUTCOME MEASURES WERE: (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings.
  
  
  RESULTS
  There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11).
  
  
  CONCLUSIONS
  All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out.
authors.affiliation: James Cook University, Queensland, Australia. yik_lim@health.qld.gov.au
authors.forename: Yik Nyok
authors.initials: YN
authors.lastname: Lim
authors.forename: Reinhold
authors.initials: R
authors.lastname: Muller
authors.forename: Audrey
authors.initials: A
authors.lastname: Corstiaans
authors.forename: Hans P
authors.initials: HP
authors.lastname: Dietz
authors.forename: Christopher
authors.initials: C
authors.lastname: Barry
authors.forename: Ajay
authors.initials: A
authors.lastname: Rane
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011793:Queensland; D016037:Single-Blind Method; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics