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New trial results indicate non-inferiority of adjustable single-incision mini-slings after three years

Prof. Mohamed Abdel-Fattah (Aberdeen, GB) today presented the results of the Single Incision Mini-Slings versus Standard Synthetic Mid-Urethral Slings in the Surgical Management of Stress Urinary Incontinence in Women (SIMS RCT). Prof. Abdel-Fattah was speaking at Game-changing Session 4 on the third day of EAU22 in Amsterdam, an indication that his team’s research had the potential to change clinical guidelines and indeed practice.

The trial was designed to show the non-inferiority of the mini-sling versus established mid-urethral slings, with respect to patient-reported success at 15 months. Two groups of 298 women across 21 British centres were followed for 36 months. The percentage of patients reporting success remained similar in the two groups at the three-year follow-up, as recently reported in the New England Journal of Medicine. The trial will continue up to the ten-year mark.

During the discussion with Prof. Chris Chapple (Sheffield, GB), it was clear that the results of the trial were welcomed. Prof. Chapple complimented the trial as “the benchmark in a market where slings are introduced with little or no research or trials.”

Prof. Chapple picked up on the higher rate of dyspareunia reported by the group of patients with the mini slings, asking if this was not a serious consideration. Prof. Abdel-Fattah explained that this was certainly one notable result of the trial, but that the overall sexual function scores between the two groups were no different. “There might be more reports of pain during intercourse,” Prof. Abdel-Fattah said, “but multidimensional sexual function, using a validated questionnaire including orgasm, frequency of intercourse, partner-related issues, show that the two groups had no significant differences.”

With the non-inferiority of mini slings now established in a clinical and patient-reported sense, other factors like the cost of their use, shorter recovery time and the advantages of installation under local anaesthesia can be taken into account, depending on the individual patient. The 2022 EAU Guidelines feature some first recommendations on the use of mini slings.

The second game-changing presentation by Mr. Christopher Harding (Newcastle-upon-Tyne, GB) looked at an alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women (ALTAR trial).

The trial demonstrated that the non-antibiotic preventative treatment methenamine Hippurate is not inferior to daily low-dose prophylactic antibiotics. It should now be considered as a new standard first-line option for UTI prevention in women with a history of recurrent episodes.

Personalised surgical management of LUTS/BPO

Following the game-changing session was the sixth of eight plenary sessions at this year’s Annual Congress. Starting with Dr. Dean Elterman’s (Toronto, CA) SIU lecture, which served as an introduction, the session was laid out as an extremely comprehensive overview and panel discussion of all of the different approaches to LUTS BPO management.

It covered all of the available surgical options from resection to vaporisation, and novel techniques like the temporarily-placed urethral opening system, all presented as an option for a single case presentation. The session ended with a panel discussion between the 11 experts, weighing the merits of the huge variety of approaches available to urologists in 2022.