Hermieu Jean-François, Milcent Stéphane
Clinique Urologique, Hôpital Bichat, 46, rue Henri Huchard, 75018 Paris.
Prog Urol. 2003 Sep;13(4):636-47.
Since the marketing and success of the TVT technique, other products have been released onto the suburethral sling market. These products can be classified according to four main criteria: TAPE: The material used in every case is polypropylene, in the form of woven monofilaments (TVT, Sparc, Monarc, Uretex Sup), multi-filaments (IVS, Safyre comprising two silicone tension bands), extruded crosslinked polypropylene (Obtape) or silicone-coated polypropylene in contact with the urethra (Uratape). A larger space between the fibres is associated with a lower theoretical risk of infection and better tissue ingrowth. The weaving process of Uretex Sap tape decreases the warping and release effect. Extruded polypropylene forms a very solid, but poorly elastic tape. It is not yet clear whether silicone-coating is an advantage or a disadvantage.
The ascending retropubic approach (TVT, Uretex Sup, IVS) is now well known. It carries a risk of bladder perforation and, more exceptionally, intestinal or vascular injuries. The descending retropubic approach (Uretex Sup, Sparc) requires more extensive vaginal dissection and carries a risk of bladder perforation. The mixed retropubic approach (Uretex Sup) combines the potential disadvantages of the ascending and descending approaches. The transobturator approach (Uratape, Obtape, Monarc) was described more recently and is easy to learn. It does not carry any risk of intestinal or vascular injury, but the urethra, vagina or even the bladder (in the case of lateral cystocele) can be damaged by this incision.
Ease of use is an essential feature. Uretex Sup comprises ancillary instruments and a technique requiring multiple manipulations. Sparc tape cannot be easily dissociated from the ancillary instruments when a second passage is necessary. TVT and Uratape use resterilizable instruments, while the other products are totally disposable. FOLLOW-UP AND PUBLICATIONS: Only TVT has a sufficient follow-up and several hundred specific papers or publications. Only a few publications by a few different teams are currently available for the other products. In conclusion, the various published studies confirm the qualities and good tolerance of woven monofilament polypropylene. The other materials require a longer follow-up and more studies before they can be completely validated in terms of results and morbidity. The multiple surgical approaches and the various ancillary instruments available allow the technique to be adapted to each patient and each surgeon, regardless of his or her initial training and habits.
自从经阴道无张力尿道中段吊带术（TVT）技术上市并取得成功以来，其他产品也已投放至尿道下吊带市场。这些产品可根据四个主要标准进行分类：
每种产品所使用的材料均为聚丙烯，形式有编织单丝（TVT、Sparc、Monarc、Uretex Sup）、复丝（IVS、Safyre包含两条硅胶张力带）、挤出交联聚丙烯（Obtape）或与尿道接触的硅胶涂层聚丙烯（Uratape）。纤维之间的空间越大，理论上感染风险越低，组织向内生长情况越好。Uretex Sap带的编织工艺可减少翘曲和释放效应。挤出聚丙烯形成的带子非常坚固，但弹性较差。目前尚不清楚硅胶涂层是优点还是缺点。
耻骨后上行入路（TVT、Uretex Sup、IVS）如今已广为人知。它存在膀胱穿孔风险，更罕见的是肠道或血管损伤风险。耻骨后下行入路（Uretex Sup、Sparc）需要更广泛的阴道解剖，且有膀胱穿孔风险。耻骨后混合入路（Uretex Sup）兼具上行和下行入路的潜在缺点。经闭孔入路（Uratape、Obtape、Monarc）是最近才描述的，且易于学习。它没有肠道或血管损伤风险，但此切口可能会损伤尿道、阴道甚至膀胱（在侧方膀胱膨出的情况下）。
易用性是一个基本特征。Uretex Sup包括辅助器械以及一项需要多次操作的技术。当需要再次操作时，Sparc带不易与辅助器械分离。TVT和Uratape使用可重复灭菌的器械，而其他产品则完全是一次性的。
只有TVT有足够的随访资料以及数百篇专门的论文或出版物。目前其他产品仅有少数不同团队发表的一些出版物。总之，各种已发表的研究证实了编织单丝聚丙烯的质量和良好耐受性。其他材料在结果和发病率方面要完全得到验证，还需要更长时间的随访和更多研究。多种手术入路和各种可用的辅助器械使该技术能够根据每个患者和每个外科医生进行调整，无论其初始培训和习惯如何。
