The fascia lata suburethral sling for treating recurrent urinary stress incontinence

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of the fascia lata suburethral sling procedure in the treatment of recurrent genuine urinary stress incontinence. STUDY DESIGN: This study was a retrospective analysis of 60 patients who had a suburethral fascia lata sling placement between January 1992 and December 1995. Follow-up ranged from 6 months to 3.5 years. The database was obtained by a retrospective chart review, a written questionnaire, and telephone interview. RESULTS: Between January 1992 and December 1995, 72 patients who had at least one previous incontinence procedure were assessed by urodynamic testing and cystourethroscopic examination before undergoing a fascia lata sling placement. Of this population, 60 were available for follow-up. Of this 60, 54, or 90%, had complete cure or marked improvement in the urinary incontinence. There were six failures, two of which had no bladder neck mobility and two of which had detrusor instability and were unable to take medication because of medical contraindications. In addition, two slings were sacrificed because of postoperative complications. The most common postoperative complication was urinary retention, which resulted in eight, or 13.4%, of slings needing to be released. CONCLUSION: Our data support the use of the suburethral fascia lata sling as an effective method for the treatment of recurrent genuine urinary stress incontinence, with urinary retention being the most common postoperative complication.(Am J Obstet Gynecol 1997;177:6)     

Sling operation for urinary incontinence

105 women with urinary stress incontinence were treated over an 8-year period. The operations carried out were: 44 Zoedler slings using mersilene and 61 slings using lyodura. Follow-up lasting from 3 to 11 years showed complete failure in 17 patients (16%). The plastic slings of the Zoedler type led to an increased risk of complications such as retropubic infections, rejection of the mersilene, and chronic urinary retention. The lyodura sling was considered good prosthetic material. Our experience shows that a sling operation, as a primary method, may be selected for patients with stress urinary incontinence and a large degree of descent of the anterior vaginal wall and/or uterus.     

A minimally invasive technique for relaxing overtentioned midurethral slings

Midurethral slings for stress urinary incontinence are effective surgical treatment with substantial rate of postoperative urinary retention. Different operative procedures ranging from urethrolysis to midline sling incision have been described to correct these cases. In this letter, we describe a minimally invasive technique for loosening overtensioned midurethral slings.     

Suburethral slingplasty evaluation study in North Queensland, Australia: the SUSPEND trial

OBJECTIVE: To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence. METHODS: Following ethics approval, 195 (3 x 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. MAIN OUTCOME MEASURES WERE: (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings. RESULTS: There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11). CONCLUSIONS: All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out.     

Comparison of long-term outcomes of autologous fascia lata slings with Suspend Tutoplast fascia lata allograft slings for stress incontinence

OBJECTIVE: This study was undertaken to compare the objective and subjective long-term surgical outcomes in patients receiving Tutoplast fascia lata allograft slings with those receiving autograft slings for the treatment of stress urinary incontinence (SUI). STUDY DESIGN: We reviewed all patients (n = 71) undergoing suburethral sling with either autologous fascia lata (n = 39) or Tutoplast fascia lata (n = 32) for urodynamic stress incontinence (USI) from October 1, 1998, to August 1, 2001. RESULTS: Of the original 71 patients, 47 were evaluated by objective and/or subjective means at a minimum of 2 years after surgery. Subjective quality of life measures, subjective continence, maximum urethral closure pressure, and bladder neck mobility were not different between the 2 groups. USI was demonstrated in 41.7% of allograft patients compared with no autograft patients (P = .007). CONCLUSION: Although patient reported cure of SUI is high for both sling types, USI recurs at a significantly higher rate in Tutoplast slings compared with autologous slings.     

Use of the Urethral Sling to Treat Symptoms of Climacturia in Men After Radical Prostatectomy

BackgroundClimacturia affects up to 45% of men after radical prostatectomy (RP). Although urethral slings decrease the severity and frequency of stress incontinence after RP, their efficacy as a treatment for climacturia after RP has not been well studied.AimThe aim of this study was to assess patient-reported changes in climacturia symptoms after implantation of a urethral sling as a treatment for stress incontinence after RP.MethodsAfter Institutional Review Board approval, a retrospective chart review identified males aged 18–80 years who received urethral slings for stress incontinence after RP at our institution from 2012 to 2017. These patients were mailed an 11-item questionnaire asking them about climacturia symptoms before and after implantation of a urethral sling. Written informed consent was obtained from patients participating in the mailed questionnaire.OutcomesRespondents were asked to report on climacturia frequency and severity, bother, partner bother, and incontinence before and after implantation of urethral slings.ResultsA total of 42 questionnaires were mailed; 17 were available for analysis. The median age (and interquartile range, IQR) of the sample at RP was 64 (59.5, 68.0). Almost all (94.1%) of the men were sexually active at the time of the study and 64.7% reported experiencing urinary leakage during sexual arousal. Most (58.8%) underwent the urethral sling procedure to treat general incontinence; 35.3% underwent the procedure to treat both general incontinence and incontinence during sexual activity and 1 (5.9%) underwent it for other reasons. A median of 28.1 months elapsed between RP and sling procedure (IQR: 18.36, 53.88; minimum: 8.00; maximum: 108.36). Statistically significant shifts toward improvement from presling to postsling were noted for frequency of leakage during sexual arousal or orgasm (P = .041) and for the degree to which leakage of urine during sexual arousal or orgasm was a “bother” (P = .027). While almost all (94%) of the men were incontinent before sling, this percentage dropped to 53% after sling (P = .031).Clinical ImplicationsUrethral slings should be discussed as a treatment strategy for climacturia during clinical consultations with patients.Strengths & LimitationsStrengths include consistent surgical technique. Limitations include retrospective design, lack of a nonsling comparison group, subjective nature of outcome measures, possible response bias, and variability in time interval between RP and sling procedure.ConclusionUse of urethral slings after RP is associated with improvements in climacturia symptoms, bother, and incontinence.Nolan J, Kershen R, Staff I, et al. Use of the Urethral Sling to Treat Symptoms of Climacturia in Men After Radical Prostatectomy. J Sex Med 2020;17:1203–1206.     

Stress urinary incontinence

Stress urinary incontinence, the complaint of involuntary leakage during effort or exertion, occurs at least weekly in one third of adult women. The basic evaluation of women with stress urinary incontinence includes a history, physical examination, cough stress test, voiding diary, postvoid residual urine volume, and urinalysis. Formal urodynamics testing may help guide clinical care, but whether urodynamics improves or predicts the outcome of incontinence treatment is not yet clear. The distinction between urodynamic stress incontinence associated with hypermobility and urodynamic stress incontinence associated with intrinsic sphincter deficiency should be viewed as a continuum, rather than a dichotomy, of urethral function. Initial treatment should include behavioral changes and pelvic floor muscle training. Estrogen is not indicated to treat stress urinary incontinence. Bladder training, vaginal devices, and urethral inserts also may reduce stress incontinence. Bulking agents reduce leakage, but effectiveness generally decreases after 1-2 years. Surgical procedures are more likely to cure stress urinary incontinence than nonsurgical procedures but are associated with more adverse events. Based on available evidence at this time, colposuspension (such as Burch) and pubovaginal sling (including the newer midurethral synthetic slings) are the most effective surgical treatments.     

A suburethral sling procedure with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low urethral closure pressure

One indication for suburethral sling procedures has been recurrent genuine stress incontinence after previous incontinence surgery. Patients with low urethral closure pressures (20 cm H2O or less) in association with genuine stress incontinence are at particular risk for failure of standard anti-incontinence procedures. Urodynamic evaluation was used to select 17 patients with genuine stress incontinence and low urethral closure pressures for surgical treatment with a sling procedure using polytetrafluoroethylene. The technique of the procedure, cure rate, and postoperative complications were assessed. An 85% subjective and objective cure rate was found on urodynamic testing three months postoperatively. Complications included wound seroma, urinary tract infection, and urinary retention.     

Sling distress: a subanalysis of the IVS tapes from the SUSPEND trial

AIM: To study the incidence of erosions and tape infections following the use of intravaginal slingplasty (IVS) treatment for stress urinary incontinence after the SUSPEND trial period of 30 months. This subanalysis was carried out because of concerns regarding high percentage of delayed sling erosions and infections during follow up of the patients who participated in the trial. MATERIALS AND METHODS: The subanalysis patient group consisted of all IVS patients drawn from the SUSPEND randomised control trial that compared the safety and efficacy of three types of suburethral slings, TVT, SPARC and IVS, for the treatment of urodynamic stress incontinence. RESULTS: A total of 62 patients were reviewed during this study conducted from April 2002 to May 2003. Continence was achieved in 88% the patients. A total of eight (13%) sling erosions were found requiring sling removal. Forty-eight (77.4%) patients were followed up at 12 months with one case of erosion (1.7%). Twenty-nine (46.8%) of the 62 patients were followed up between 12 and 34 months, and seven cases of sling erosions were diagnosed. One patient had purulent suprapubic sinus, five patients had foul-smelling discharge, and one had recurrent urinary tract infection associated with pain and discharge. After the slings were removed the patients had no further symptoms. However, three of them had recurrent stress urinary incontinence. DISCUSSION/CONCLUSION: The delayed presentation of the sling erosion from this subanalysis is a concern, and pelvic reconstructive surgeons using IVS need to be aware of the delayed presentations we found in our cohort of patients.     

Suburethral sling treatment of occult stress incontinence and intrinsic sphincter deficiency in women with severe vaginal prolapse of the anterior vs posterior/apical compartment

OBJECTIVE: The purpose of this study was to compare the efficacy of a Mersilene mesh suburethral sling for occult stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) in women with severe vaginal prolapse of the anterior compartment to the posterior/apical compartment. STUDY DESIGN: This was a retrospective study that compared women with stage or grade III/IV prolapse of the anterior compartment (group 1) with the posterior/apical compartment (group 2); both groups demonstrated occult SUI (leakage only with prolapse reduced) and ISD on urodynamics, and underwent concurrent pelvic reconstructive surgery. The sling was defined as efficacious if SUI was prevented in 85% of women and if obstructive symptoms (de novo or worsening urge incontinence, or urinary retention greater than 2 weeks) occurred in less than 10% of women. RESULTS: There were 39 women in group 1 and 25 women in group 2. There were no differences between women in group 1 or group 2 in preoperative demographics (except parity) or urodynamic findings. SUI cure rates were lower for group 1 than group 2, but this difference was not significant (87% vs 100%, P = .15). Rates of de novo or worsening urge incontinence (8% vs 4%, P = 1.00) and urinary retention (none occurred) were similar between groups. CONCLUSION: In women with severe vaginal prolapse, slings effectively treat occult SUI and ISD, whether associated with anterior or posterior/apical prolapse.     

Effects of pubovaginal sling procedure on patients with urethral hypermobility and intrinsic sphincteric deficiency: would they do it again?

OBJECTIVE: This study was undertaken to assess the cure rate of stress urinary incontinence, long-term effects on other lower urinary tract symptoms, and quality of life in a cohort of patients who underwent pubovaginal sling procedures for treatment of incontinence related to intrinsic sphincteric deficiency and urethral hypermobility. STUDY DESIGN: This was a retrospective analysis of 57 patients with 90% follow-up who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence related to urethral hypermobility and intrinsic sphincteric deficiency. Objective postoperative urodynamic evaluation was performed in 34 (60%) of the cases. Telephone interviews to assess quality-of-life parameters were performed in all cases. RESULTS: The mean follow-up period was 42 months and the median follow-up period was 34 months, with a range of 0.5 to 134 months. The age at the time of the sling procedure ranged from 18 to 84 years, with a median parity of 3.0 (range, 0-6). Preoperative body mass index ranged from 19.5 to 39.1 kg/m(2). Five percent of patients had detrusor instability before the operation. Forty-one percent (41%) of the patients who underwent postoperative urodynamic evaluation had voiding dysfunction. The postoperative objective cure rate for stress urinary incontinence was 97%. Of all patients 88% indicated that the sling had improved the quality of life, 84% indicated that the sling relieved the incontinence in the long-term, and 82% would choose to undergo the procedure again. CONCLUSION: Construction of a pubovaginal sling is an effective technique for relief of severe stress urinary incontinence. Voiding dysfunction is a common side effect. Despite this problem, a significant number of patients would elect to undergo the procedure again.     

经阴道尿道中段补片悬吊术治疗压力性尿失禁的临床观察

目的评价经阴道尿道中段补片悬吊术治疗压力性尿失禁(SUI)的近期疗效。方法2003年7月—2004年2月,对确诊为SUI的82例患者,在局部麻醉下行经阴道尿道中段补片悬吊术,并于治疗后1、3、6个月进行随访。根据患者的主诉,以能自控排尿、无尿失禁症状为治愈;尿失禁次数及漏尿情况较术前明显减少为改善;尿失禁症状未改善或加重为无效,观察疗效及并发症。结果82例患者平均手术时间(27±9)min,平均出血量(21±6)ml。72例术后2h去除导尿管后能自行排尿,24h后测量残余尿<100ml,术后48h出院;10例术后2h去除导尿管后出现短暂尿潴留,再次留置导尿管48h后排尿正常,再观察24h后出院。82例患者出院时78例为治愈,4例(合并脑出血后遗症患者)为改善。76例随访1~6个月,其中74例为治愈,2例为改善。无发生尿潴留、尿路感染及膀胱功能障碍者。结论经阴道尿道中段补片悬吊术治疗SUI方法简单、近期效果确切。     

A comprehensive review of suburethral sling procedure complications

The study objective was to review the existing literature regarding complications of anti-incontinence sling procedures. PubMed listings using keywords related to slings and associated complications with no date or language restrictions through May 2007 and the Manufacturer and User Facility Device Experience Database were searched for specific device- and procedure-related complications. Where no information was available, published abstracts were cited. Published reports of complications for all types of anti-incontinence sling procedures are analyzed and reported. Sling-related complications are multiple but can be summarized from studies on 13737 cumulative patients as involving: voiding dysfunction (8 studies, 881 patients, 16.3% average overall incidence [OI]); detrusor overactivity (20 studies, 1950 patients, 15.4% OI); urinary retention (14 studies, 943 patients, 14.2% OI); erosion/extrusion (19 studies, 2197 patients, 6.03% OI); impact on quality of life-dyspareunia (2 studies, 175 patients, 4.3% OI); infections-most often urinary tract infections but severe infections such as abscess are reported (19 studies, 1487 patients, 5.5% OI); hematoma-most often pelvic or vaginal (4 studies, 3691 patients, 2% OI); pain (6 studies, 597 patients, 7.3% OI); abdominal and pelvic organ injury-bladder, urethra, vagina, and intestines (10 studies, 1816 patients, 3.3% OI); systemic complications-deep vein thrombosis, sepsis (case reports); and death (case reports). Cure rates for all slings are as follows: subjective (16 studies, 1541 patients, 95% OI, range 63%-99%), objective (15 studies, 1203 patients, 82% OI, range 51%-97%), and failure (8 studies, 599 patients, 11.5% OI, range 4%-37%). It is likely that sling-related complications are under-reported in the published medical literature and in the Manufacturer and User Facility Device Experience Database. This review reports on the incidence of known complications for all types of slings. Some complications are common to all sling techniques; however, with development of minimally invasive slings, device-related complications are reported and compared.     

Is transobturator suburethral sling effective for treating female urodynamic stress incontinence with low maximal urethral closure pressure?

ObjectiveTo assess retrospectively the efficacy and safety of MONARC (American Medical Systems) transobturator suburethral slings in the treatment of female urodynamic stress incontinence with and without low maximal urethral closure pressure (MUCP).Materials and MethodsSeventy-three women with urodynamic stress incontinence, fitted with the transobturator suburethral sling at a medical center in central Taiwan, participated in the study. Objective postoperative evaluations, including a 1-hour pad test, cough stress test, uroflowmetry, and residual urine volume, were conducted 6 months after operation. Subjective outcomes were evaluated by telephone interview. Charts were reviewed for perioperative complications, urinary retention, and requirements for postoperative medication for symptoms of urgency. The mean follow-up was 48 months.ResultsObjective cure rate was 80.8% (dry pad test and negative stress test), 82.4% for MUCP less than 30 cmH₂O, and 80.4% for MUCP greater than 30 cmH₂O (p = 1.000). Mean pad weight gain changed from 25.8 g preoperatively to 1.8 g postoperatively (p < 0.05). There was no significant change in urinary flow rate or residual volume. Subjectively, 98.6% of subjects experienced complete improvement; only one patient found no improvement. Very few perioperative complications occurred. Immediate postoperative difficulty in voiding occurred in 6.8% of patients. Postoperative de novo urgency was 2.7%.ConclusionsThe MONARC transobturator suburethral sling is a safe and highly effective treatment for stress urinary incontinence even in women with low MUCP at a mean follow-up of 48 months. Evaluation of the outcomes after a longer follow-up period is necessary.     

Recent Advances in Tape Slings for Female Urinary Stress Incontinence

Sling therapy is the enhanced surgical support of the urethra. In this article, the history of the use of slings for the surgical treatment of female urinary stress incontinence is reviewed, and the usual surgical routes for retropubic (transvaginal) or transobturator tape passage are described. The latest innovation in sling therapy is the use of minislings, which are short tape mesh implants inserted through a single vaginal incision; these slings may be placed in an office setting. Outcomes data are either lacking or suggest a considerable decrement of effectiveness of unstabilized minislings over full-length slings; however, the short-term efficacy of a stabilized, adjustable minisling is 97%. These results suggest benchmark effectiveness associated with full-length slings in a less invasive device that also has the capability of short-term adjustability.Key words: Minisling, Urinary stress incontinence, Retropubic sling, Transvaginal tape, Subfascial or transobturator sling, Suburethral slingUrodynamic stress incontinence (USI) is the leakage of urine through an incompetent urethra in the absence of a detrusor contraction.¹ The purest symptom of USI is urinary loss upon raising intra-abdominal pressure, as in coughing. Ten percent of middle-aged women report weekly incontinence,² although only 1 in 1000 women undergo curative surgery. USI may be complicated by intrinsic sphincter deficiency (ISD), detrusor overactivity or voiding disorder, or pelvic organ prolapse. USI is amenable to physical therapy and to surgery. Drug therapy to remedy a structural defect has been understandably disappointing. Bulking agents have a role in treating women with ISD, those who have undergone repeat surgery, or those medically unfit for surgery.     

Autologous Fascial Slings for Surgical Management of Stress Urinary Incontinence: A Come Back

Stress urinary incontinence (SUI) is a common type of urinary incontinence adversely affecting the quality of life of women. For mild SUI, life style changes, pelvic floor exercises and medical treatment with duloxetine may help. Most patients of moderate to severe SUI usually require surgical treatment. Various surgical treatment options include Kelly’s plication, Burch colposuspension, bulking agents and sling surgeries. Although, suburethral fascial slings including the autologous rectus fascia slings were in vogue before 1990, they were overtaken by minimally invasive, faster and easier artificial midurethral slings (tension free vaginal tape and transobturator tape). However, observation of serious long-term and life changing complications of synthetic midurethral slings like mesh erosion, chronic pelvic pain and dyspareunia led to their adverse publicity and medico legal implications for the operating surgeons. This led US FDA (Food and Drug Administration) to issue a warning against their use. Currently, their use has significantly decreased in many countries, and they are no longer available in some countries. This has led to renaissance of use of natural autologous fascial sling, especially rectus fascia for surgical management of SUI. Although performing rectus fascia sling surgery is technically more challenging, takes longer, has more short-term morbidity like voiding dysfunction, their long-term success is high with very little risk of serious complications like mesh erosion, chronic pelvic pain and dyspareunia. However, multicentric trials and longer follow ups are needed before it’s routine recommendation This review discusses the role of autologous fascial sling (especially rectus fascia) for the surgical management of SUI in the current time and the need of ongoing training of this procedure to gynecology residents and urogynecology fellows.     

Determinants of voiding after three types of incontinence surgery: a multivariable analysis

OBJECTIVE: To determine the time to normal voiding in women after various surgical procedures for genuine stress urinary incontinence (GSUI) or urethral hypermobility. METHODS: One hundred one women had bladder neck suspensions. Suprapubic catheters were used in 94 women and intermittent self-catheterization in seven to manage urinary retention after surgery. We used a standardized protocol to record days to adequate postoperative voiding. Univariable and multivariable regression analyses were used to determine clinical, urodynamic, and surgical factors that independently influenced time to adequate postoperative voiding. RESULTS: Women met the criteria for adequate voiding a mean of 7.1 days after modified open Burch procedures (n = 43), 9.5 days after anterior colporrhaphies with suburethral plication (n = 24), and 19.1 days after vaginal wall sling procedures (n = 34). The type of bladder neck suspension was independently associated with increasing time to void (P =.001). Multivariable regression analysis determined other factors significantly associated with longer time to adequate postoperative voiding: advancing age, previous vaginal bladder neck suspension, increasing volume at first sensation on bladder filling, higher postvoid residual urine volume (preoperative), and postoperative cystitis. Detrusor pressure, abdominal straining on pressure flow voiding study, and other concurrent surgeries were not significantly associated with postoperative voiding time in this model. CONCLUSIONS: Time to adequate voiding after bladder neck suspension was influenced by type of surgical procedure, postoperative cystitis, and several demographic and urodynamic factors. This study does not support using pressure flow studies to predict women at risk of voiding dysfunction.     

The Use of an Ultrasound Bladder Scanning Device in Women Undergoing Urogynaecologic Surgery

Objective: To compare the accuracy of using a bladder scanner to measure post-voiding residual urine volume with measurement by intermittent catheterization in a postoperative urogynaecology population.Methods: Prior to implementation of the study, nurses were trained in the use of a bladder ultrasound scanner. Post-void residual urine volume in postoperative patients was assessed by a nurse with the scanner; a second nurse, blinded to the scanner result, then catheterized the patient’s bladder. Each patient rated the pain experienced with bladder scanning and with catheterization. A prospective comparison of the volumes assessed by ultrasound and measured by catheterization used 127 pairs of data; each woman served as her own control. The correlation of urine volumes was determined, and the difference in pain score was calculated using the Student t test.Results: The mean age of patients was 56.5 years (range 40–79). All four bladder quadrants were visualized in 34.4% of scans. The correlation coefficient for volumes measured by scanning and catheterization was 0.70 (P < 0.001; range -349 mL to + 692 mL). Consistently, using the scanner resulted in underestimation of the urine volume. The sensitivity of the bladder scanner (0.58 for residual volumes> 200 mL) therefore makes it a poor tool for assessing postoperative urinary retention in women undergoing urogynaecologic surgery. Pain scores recorded with catheterization (2.9/10) were significantly less than those recorded with bladder scanning (4.2/10) (P < 0.001).Conclusions: Bladder scanning by staff nurses had limited value in assessing postoperative residual urine volumes. The accuracy of assessment might increase with greater experience with the procedure. The greater discomfort reported by patients with use of the scanner supports continued use of catheterization to assess residual urine volume.     

Neue Entwicklung vaginaler Inkontinenzoperationen

Vaginal repair has long been the procedure of choice for gynecologists to treat female urinary incontinence. High failure and recurrence rates in objectively controlled studies have guided towards abdominal procedures such as colposuspension and traditional slings. Tension-free vaginal tape (TVT) has proven to be an excellent choice in female stress urinary incontinence without prolapse or other pathology, especially in patients at risk. Severe paravaginal defects and additional pathology leave a wide spectrum for the traditional colposuspension. Further long-term follow-up and comparative studies will have to show whether the good results with TVT can be stabilized and which complications with the alloplastic sling material might arise. With many questions unanswered, we are very cautious with implanting TVT in very young women.     

Surgical treatment of stress urinary incontinence by suburethral transobturator tape

OBJECTIVE: Assessment of the suburethral transobturator tape in the treatment of female urinary stress incontinence. PATIENTS AND METHODS: Retrospective evaluation of 39 slings. Three patients (7%) were lost to follow-up. Analysis was carried on 19 out/in procedures (mainly ObTape and Uratape slings) and 17 in/out procedures (TVT-O slings). Nine patients (25%) had a history of previous stress incontinence surgery. In 21 cases (58%) there was a concomitant surgical procedure, including genital prolapse repair (12) and total hysterectomy (6). Phone interviews were conducted with the validated questionnaires MHU and Ditrovie short form. RESULTS: The mean operative time was 17 minutes (10-30). Three vaginal wounds (8%) were immediately repaired. Two urinary retentions (5%) were managed by suprapubic catheterization for more than 10 days. With a mean follow-up of 12 months (4-23) the subjective effectiveness on stress incontinence was 89% (cure: 58%; improvement: 31%). Urge incontinence symptoms were cured in 47% of mixed incontinences. Two patients reported an important dysuria. Two sling exposures occurred. Quality of life scores were significantly improved (mean 1,7 versus 3,2, p=0,002). The level of satisfaction reached 89% (very satisfied: 50%; satisfied: 39%). DISCUSSION AND CONCLUSION: This technique is safe and effective. Our results are nevertheless inferior to those previously reported. Prospective randomised studies comparing the two surgical routes are required.