Comparison of Efficacy and Side Effects Between the Obtryx and Solyx Band With 5-year Follow-up.

Comparison of Efficacy and Side Effects Between the Obtryx and Solyx Band With 5-year Follow-up. Prospective, Randomized and Non-inferiority Study

Boston2018 post-market clinical study is a prospective, randomized, non-inferiority study to assess the efficacy and adverse events of the Solyx™ Single Incision Sling (SIS) System compared to the gold-standard Obtryx™ II Sling System, in patients with stress urinary incontinence (SUI) and long-term follow-up (5 years).

Randomized prospective non-inferiority study, in which we evaluate patients with stress urinary incontinence (SUI) who undergo surgical treatment consisting of a minimal incision in the suburethral area of the vaginal mucosa for a mesh insertion in order to: Main Objective: To compare the continence rate (objective) between Solyx and Obtryx II meshes in patients with SUI. This rate will be determined by an effort test. Secondary Objectives: To compare the continence rate (subjective) between both meshes. To compare variations in Pad-Test. To asses patient satisfaction. To evaluate both techniques regarding quality and sexual life modifications. To compare both techniques regarding early complications (up to 30 days post implantation). To compare the appearance and persistence of late complications (from 30 days onwards).

The Solyx™SIS System is an innovative mid-urethral sling single incision system consisting of a 9 cm long polypropylene mesh, whose mid-urethral portion (4 cm) is detanged to potentially resist deformation and to reduce irritation to the urethral wall. Snap-fit to delivery device tip allows for advanced placement control and, therefore, the tensioning through the forward and reverse functions performed with this delivery device.

The Obtryx II System (Halo) is a transobturator sling designed to allow inter-operative adjustability with minimal tissue disruption. It consists of two delivery devices (one patient right and one patient left) and one mesh assembly. The mesh assembly is comprised of a polypropylene knitted mesh with dilator legs and a center tab. At the distal ends of the dilator legs there are association loops designed to be placed in the needle slot of the distal end of the delivery device. The disposable delivery device consists of a handle with a stainless steel needle. The needle is designed to facilitate the passage of the mesh assembly through bodily tissues for placement through the obturator foramen.

For the analysis of the objective cure of incontinence, an effort test will be carried out through three strokes of cough, with bladder volume between 200-300 ml in a lithotomy position.

For the analysis of the objective cure of incontinence, an effort test will be carried out through three strokes of cough, with bladder volume between 200-300 ml in a lithotomy position.

For the analysis of the objective cure of incontinence, an effort test will be carried out through three strokes of cough, with bladder volume between 200-300 ml in a lithotomy position.

For the analysis of the objective cure of incontinence, an effort test will be carried out through three strokes of cough, with bladder volume between 200-300 ml in a lithotomy position.

For the analysis of the objective cure of incontinence, an effort test will be carried out through three strokes of cough, with bladder volume between 200-300 ml in a lithotomy position.

For the analysis of the objective cure of incontinence, an effort test will be carried out through three strokes of cough, with bladder volume between 200-300 ml in a lithotomy position.

For the analysis of the objective cure of incontinence, an effort test will be carried out through three strokes of cough, with bladder volume between 200-300 ml in a lithotomy position.

Incontinence Questionnaire-Urinary Short Form (ICQ-SF): continent patient when the reduction is equal to or greater than 50% of the value prior to the intervention.

1 hour pad test: After a spontaneous urination the patient will place a compress that will be weighed previously. After, the patient has to drink a half liter of water in 15 minutes sitting. Between the minute 15 to 45 has to walk and / or go up / down stairs. From minute 45-60 the patient has to get up and sit 10 times, cough 10 times, run 1 minute, lift an object from the ground 10 times and washes his/her hands 1 minute. According to the difference in weight of the compress, it will be cataloged as follows: ≤ 1 gram -> continent. 1.1-9.9 grams -> mild incontinence. 10-49.9 grams -> moderate incontinence. > 50 grams -> severe incontinence

Global satisfaction assessment will be required, with a rank 1-5, being 1 very satisfied and 5 very dissatisfied.

The recommendation grade will be assessed through the question "will you recommend this surgical treatment for other patients?", the possible answer are Yes or No.

Evaluation of life quality improvement assessed by I-QoL questionnaire (Urinary Incontinence-Specific Quality of Life Instrument)

To assess the life quality impact, I-QoL questionnaire (Urinary Incontinence-Specific Quality of Life Instrument) will be used , this questionnaire, is composed by 22 items. The highest punctuation mean better life quality. The modification of 2.5 points, which has been considered in this questionnaire, is the minimum clinically significant modification in patients presenting SUI. This questionnaire is validated in Spanish.

Evaluation of sexual life, assessed by PSIQ 12 questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire )

To assess the impact on sexual life, the PSIQ 12 questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire ) will be used. It is composed of 12 items graded from "never" to "always". This questionnaire is validated in heterosexual women who have urinary incontinence and / or pelvic organ prolapse. Scores are calculated for each item with a value of "always = 0" and for "never = 4". It is used inversely in items 1-4.

Are considered by the urgency of urination, the inability to void, the presence of PMR greater than 50% of the total volume after spontaneous voiding or the presence of pain that prevents ambulation, in the first 30 days after the intervention. For the elevated PMR assessment, perineal ultrasound measurement will be carried out after spontaneous micturition. If the PMR measurement will be higher or equal, probing would be performed to obtain the exact residue. If it is pathological, proceed according to the usual practice.

Early complications assessed by OAB-q questionnaire (Overactive Bladder symptom and health-related quality of life questionnaire)

OAB-q questionnaire (Overactive Bladder symptom and health-related quality of life questionnaire). Individual answer punctuation: lowest 0, highest 5 .If the score ≥8 will proceed according to the usual practice.

Long term complications assessed by OAB-q questionnaire (Overactive Bladder symptom and health-related quality of life questionnaire)

OAB-q questionnaire (Overactive Bladder symptom and health-related quality of life questionnaire). Individual answer punctuation: lowest 0, highest 5 .If the score ≥8 will proceed according to the usual practice.

Only when the patient has a pain that prevents ambulation. VAS: Pain scale for quantification of pain. Range 0 to 10. 0: No pain 5: Distressing pain 10: Unbearable pain

Extrusion: The integrity of the vaginal mucus will be checked in all the visits that are made. If there is evidence of mesh extrusion, it is classified as asymptomatic / symptomatic and according to its size (greater or less than 1 cm).

Urinary tract infection: in the presence of at least 1 monthly urinary tract infections (UTI), the patient will be considered to have developed repeat UTIs.

Inclusion Criteria: patients diagnosed with symptomatic stress urinary incontinence candidates for stress-free bands Age > or = 40 years informed consent signed by the patient Exclusion Criteria: patients who are pregnant or wish to become patients who need anticoagulant active vaginal or urinary infection previous surgical interventions for the treatment of incontinence body mass index > 35

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