title: Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study.
abstract: OBJECTIVE
  The objective of the study was to compare the safety and efficacy of surgeon-tailored polypropylene mesh (STM) through tension-free vaginal tape-obturator (TVT-O) versus original TVT-O in the treatment of stress urinary incontinence (SUI) aiming to decrease the cost of treatment. This is important in developing countries due to limited health care resources.
  
  
  METHODS
  A retrospective cohort study was done at the Urology and Gynecology Departments (dual-center), Cairo University from May 2007 to June 2010. Women evaluated by cough stress test, Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ), maximum flow rate (Qmax), and abdominal leak point pressure (ALPP) with follow-up for at least 48 months were included. Patients with post-void residual urine > 100 ml, bladder capacity < 300 ml, or impaired compliance were excluded. The effect of different factors on outcome was compared between both groups pre- and postoperatively using the paired t, Wilcoxon signed rank, McNemar, chi-square, Fisher's exact, independent t, or Mann-Whitney tests.
  
  
  RESULTS
  STM and TVT-O were inserted in 79 and 66 women, respectively. Intrinsic sphincter deficiency, ALPP, previous surgeries, associated urgency, urgency urinary incontinence (UUI), and prolapse were comparable in both groups. Operative duration was longer in STM by 10 min. No significant difference was found between both groups in complications (p = 0.462), cure (p = 0.654), and different indices of SUIQQ. In STM, 74 (93 %) were cured and 3 (4 %) improved, while SUI persisted in 2 (2 %) patients. In TVT-O, 59 (89 %) were cured and 4 (6 %) improved, while failure was detected in 3 (4 %) patients.
  
  
  CONCLUSIONS
  The 5-year outcome is comparable between STM and TVT-O. Furthermore, STM is more economical due to our resterilizable modified helical passers and the cheap polypropylene mesh.
authors.affiliation: Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt. mohammedshemy@yahoo.com.
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: ElSheemy
authors.affiliation: Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Fathy
authors.affiliation: Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Hussein A
authors.initials: HA
authors.lastname: Hussein
authors.affiliation: Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Ragheb
authors.initials: R
authors.lastname: Elsergany
authors.affiliation: Department of Gynecology and Obstetrics, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Eman A
authors.initials: EA
authors.lastname: Hussein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000706:statistics & numerical data*; D013526:Surgical Mesh / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
chemical_list: D011126:Polypropylenes
keywords: Cost; Female stress urinary incontinence; Polypropylene mesh; Surgeon-tailored mesh; TVT-O, TOT