according to the european association of urology guidelines on urinary incontinence , concerning the treatment of female stress urinary incontinence ( sui ) , the retropubic insertion of a midurethral synthetic sling ( mus ) gives equivalent patient - reported cure of sui at 12 months , when compared to colposuspension .
these guidelines also report that midurethral synthetic sling inserted by either the transobturator ( to ) or retropubic ( rp ) route gives equivalent patient - reported outcome at 12 months . with an obvious trending towards less and less invasive surgical options , single - incision vaginal slings ( sis ) have emerged .
they require very limited intracorporeal dissection , proposing to further increase safety of suburethral slings , without jeopardizing the success rates reported by conventional rp and to access .
these sis outcomes are comparable with conventional mus at short - term follow - up [ 35 ] . although sparse , two - year follow - up studies are available and seem to maintain steady success rates over this time [ 6 , 7 ] .
longer follow - up time reports are needed , to ensure that , in the long run , these sis offer constant success rates .
the objective of this study is to describe the outcome of women treated with mini - arc at a mean follow - up of 45 months , based on a baseline population which has already been reported in a short - term paper , after adequate long - term follow - up evaluation .
previously considered cured and improved patients were evaluated to access if their condition remains stable , as reflected in a subjective satisfaction evaluation .
this is a single - centre prospective evaluation of women with urodynamic stress urinary incontinence , which were submitted to mini - arc ( american medical systems , minnetonka , mn , usa ) placement as a primary surgical treatment .
surgical technique , inclusion and exclusion criteria , baseline population characteristics , and short - term outcome and complications have already been described in a previous paper . on this report , on 105 women with a mean follow - up of 15 months ( and a minimum follow - up of 6 months ) , 84 patients ( 80% )
now , with a mean follow - up of 45 months , cured / improved patients were reassessed by telephone interview and completed patient global impression of improvement ( pgi - i ) , to access treatment response , patient global impression of severity ( pgi - s ) , to access current sui condition , rated their improvement in a 0100 scale , and answered if they would recommend the procedure .
this study was approved by the institutions ' ethics committees and each participant provided written informed consent prior to enrollment .
at 15-month mean follow - up ( initial population of 105 patients ) , 84 patients were cured and 12 improved .
seventy - seven patients could be contacted ( 80% of the initial population ) and have a current mean follow - up of 45 months ( median 43.5 months ) .
three were submitted to other forms of sui treatment during the period of follow - up .
so , from a total of 77 responders , 70 ( 91% ) maintained the initial cure / improvement situation ( figure 1 ) .
fifty - three of the cured patients ( 84% ) rated the improvement of sui by the pgi - i as  very much better  or 
much better  and 4 ( 6% ) considered it to be  a little better .  four patients ( 6% ) answered  no change  and two ( 3% )  a little worse 
the mean rate of improvement in a 0100 scale was 81  15 , 52 patients ( 83% ) rating improvement > 70 .
fifty - four patients ( 86% ) reported their urinary tract condition ( utc ) to be  normal  on pgi - s ( figure 3 ) .
when analyzing improved patients ( n = 7 ) , 2 ( 29% ) considered their pgi - i as  very much better  or  much better ,  1 ( 14% )  a little better ,  and 4 ( 57% )  no change 
( figure 2 ) . only 3 patients ( 43% ) rated their improvement to be equal or superior to 70% in a 0100 score or
five patients ( 71% ) answered  moderate  on pgi - s , with only two patients ( 29% ) considering their utc to be 
female urinary incontinence is a very common condition , which can affect around 35% of women ; sui is the most prevalent type , but the consultation and treatment rates are very low .
the conservative management is the first treatment option and it usually includes pelvic floor muscle training , which can be very successful in around a fourth of the patients , especially in younger patients with mild forms of the condition .
obese women can adopt a program of weight reduction associated with physical exercise , which can offer a 25% cure rate , since they stay firmly devoted to the program over time and are willing to wait for the improvements . as a result
, surgery is the most common form of sui treatment worldwide . during the last 2 decades we have observed the development of promising sui surgical techniques and the introduction of suburethral , tension - free slings .
tvt ( gynecare , ethicon , somerville , new jersey , usa ) was the first device of this kind to be introduced in clinical practice , in 1996 by ulmsten et al . .
according to the european association of urology guidelines on urinary incontinence , the rp insertion of a mus gives equivalent patient - reported cure of sui at 12 months , when compared to colposuspension .
nonetheless , tvt shows low invasiveness , short hospital stay , reduced risk of prolonged catheterization , and low risk of causing future pelvic organ prolapsed .
all together , these characteristics were responsible for the swift replacement of burch colposuspension as the preferred surgical approach to female sui .
tvt has become the gold standard in the surgical treatment of sui with high cure rates that subsist at long time follow - up .
the blind passage of needles through the rp space was associated with severe complications , such as bladder and bowel perforations and life - threatening vascular injuries [ 16 , 17 ] .
these concerns led to the development of the to route in 2000 , a relatively avascular space for the passage of trocars .
however , to tapes have been associated with prolonged and limitative pain referred to the groin and upper thigh , due to the obturator foramen violation and vaginal perforations due to a more horizontal trajectory of the needle passage [ 16 , 17 , 19 ] . to our knowledge , this is the longest follow - up prospective report on mini - arc single - incision sling . at roughly four - year follow - up ,
the majority of patients cured or improved at short - term evaluation maintain a high degree of satisfaction at long term .
short- and midterm reports on mini - arc have , on the majority , been consistent with the initial results of this series [ 6 , 7 ] and comparable to conventional mus [ 20 , 21 ] , with a low morbidity profile [ 20 , 21 ] . the number of patients available for this evaluation , with 80% responders at almost 4-year mean follow - up , permits having an adequate idea of the long - term outcomes of the initial population , in a reliable way .
patient global impression of improvement questionnaire addresses the sui treatment outcomes when compared with baseline condition and the results among the cured patients describe a 90% ( 57 patients ) positive result , with 84% of the patients considering their actual condition to be  very much better  or  much better ,  which is usually assumed to be equal to a cured situation .
these numbers are certainly reliable , as the 0100 improvement scale results mean score is over 80% , with over than 4/5 of the cured patients rating this improvement > 70% . on the other way , the actual urinary tract condition , addressed by pgi - s , is considered  normal  by 86% of the cured women .
the improved - patient population is very small ( n = 7 ) , and interpreting their results would not prompt solid conclusions .
these reports on long - term evaluation are very important to assure that sis are a valid technique , with fair and comparable results at short- and middle - term evaluations , and that over time the results are maintained stable .
this study shows that the majority of patients cured / improved after mini - arc placement maintain a high degree of satisfaction at a long - term evaluation .
 single - incision slings were introduced in the surgical treatment of female stress urinary incontinence ( sui ) to lessen the morbidity associated with traditional midurethral slings . however , long - term reports on patient satisfaction are still scarce . 
 this study describes the outcome of women treated with mini - arc at a mean follow - up of 45 months . in a previous report on 105 women with 15-month mean 
 follow - up , 84 ( 80% ) were found cured and 12 ( 11% ) improved . 
 now , with a mean follow - up of 45 months , cured / improved patients were reassessed by telephone and completed patient global impression of improvement ( pgi - i ) , patient global impression of severity ( pgi - s ) , rated their improvement in a 0100 scale , and answered if they would recommend the procedure . at 45-month follow - up , 73 women cured 
 / improved were available for evaluation . 
 over 80% of the cured patients rated the improvement of sui by the pgi - i as  very much better  or  much better ,  reported their urinary tract condition to be  
 normal  on pgi - s , and described their improvement > 70% . 
 ninety percent would recommend this procedure to a friend . 
 the improved - patient population is very small ( n = 7 ) . 
 this study shows that the majority of patients cured / improved after mini - arc placement maintain a high degree of satisfaction at a long - term evaluation . 
1. Introduction
2. Materials and Methods
3. Results and Discussion
4. Conclusions