Dear Editor
We read the recent article by Cheng-Yu Long et al. with interest [1]. The data since publication of the first midurethral minisling in 2005 by Petros and Richardson [2] support the editorial statement [1]. The first midurethral minisling was, and remains, a tensioned retropubic sling. Since then, it has been validated by a 5-year RCT by Sivaslioglu who compared the TFS minisling with a TOT (transobturator tape) [3] with objective cure rates of 75% and 83% TFS at 5 years. There was one TOT erosion (2.5%) and one TFS anchor displacement in the left side. The anchor was removed under local anesthesia, and the patient remained continent.
Since 2006, our Japanese group has performed > 500 TFS minisling operations for stress urinary incontinence (SUI). We reported 90% 3-year SUI cure for TFS minisling with no erosions [4]. Five patients needed indwelling catheters, and all five patients voided without difficulty within 2 days. There were no intraoperative complications and no erosions within the 3 years. We also reported 90.9% cure at 12 months for women with intrinsic sphincter defect (ISD) (patients with maximum urethral closure pressure < 20) [5]. There was one intraoperative bladder perforation, but no erosions. All our operations were performed under local anesthetic (LA)/sedation with same-day discharge.
All operations were performed with a third-generation non-stretch lightweight tape. The TFS minisling is unique in that it is retropubic and uses a one-way tensioned tape. As such, it can be tightened millimeter by millimeter to obtain the precise tension required for closure with minimal postoperative urinary retention, an important consideration for ISD [5]. The minimal nature of the operation allows it to be done under LA. Furthermore, reports of a retropubic being superior to TOT for repeat surgery give this method an added advantage over the TOT minislings.
Footnotes
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Contributor Information
H. Inoue, Email: ino-hiromi@jcom.home.ne.jp
Y. Sekiguchi, Email: dumbo-ys@d9.dion.ne.jp
R. Nakamura, Email: ryokosakata@hotmail.com
References
- 1.Long C-Y, Chen G-D, Rogers RG. Can the mini-sling become the golden standard for treating stress urinary incontinence? Int Urogynecol J. 2021;32:1–2. 10.1007/s00192-020-04249-w. [DOI] [PubMed]
- 2.Petros PEP, Richardson PA. The midurethral TFS sling- a ‘micro-method’ for cure of stress incontinence- preliminary report. ANZJOG. 2005;45:372–5. [DOI] [PubMed]
- 3.Sivaslioglu AA, Eylem U, Serpi A, et al. A prospective randomized controlled trial of the transobturator tape and tissue fixation minisling in patients with stress urinary incontinence: 5-year results. J Urol. 2012;188:194–9. [DOI] [PubMed]
- 4.Nakamura R, Yao M, Maeda Y, Fujisaki A, Sekiguchi Y. Outpatient mid-urethral tissue fixation system sling for urodynamic stress urinary incontinence: 3-year surgical and quality of life results. Int Urogynecol J. 2017;28(11):1733–8. 10.1007/s00192-017-3341-4. [DOI] [PMC free article] [PubMed]
- 5.Nakamura R, Yao M, Maeda Y, Fujisaki A, Sekiguchi Y. Retropubic tissue fixation system tensioned mini-sling carried out under local anesthesia cures stress urinary incontinence and intrinsic sphincter deficiency: 1-year data. Int J Urol 2017;24(7):532–537. [DOI] [PubMed]