Suburethral sling procedure for genuine stress incontinence and low urethral closure pressure. A continued experience

Forty-eight patients with genuine stress incontinence and low urethral closure pressure have undergone a suburethral sling procedure using polytetrafluoroethylene. Forty-five of the 48 patients have been followed up beyond 3 months, allowing assessment of postoperative complications. Ten patients required intermittent self-catheterization, 6 continuing beyond 3 months secondary to obstructed voiding or vesical dysfunction. Six slings were removed due to graft infection and/or vaginal mucosa erosion. All patients who were continent prior to removal remained so afterwards. Two slings were loosened secondary to obstructed voiding (1 patient experienced improved voiding, the other continued intermittent catheterization). Sixty-two per cent (28/45) of the patients followed, developed at least one documented urinary tract infection. Thirty-four of the 45 patients followed, underwent postoperative multichannel urodynamic testing. Ten patients (29%) demonstrated postoperative detrusor instability (5 were new onset, 5 were persistent). Six improved with medication and bladder retraining drills. Twenty-eight of the 34 patients tested (82.4%) were objectively cured of genuine stress incontinence. In spite of the complications noted, this suburethral sling procedure offers a high success rate and is a viable alternative in treating patients with genuine stress incontinence and low urethral closure pressure. Modifications in surgical technique have been made to reduce postoperative complications in the future.     

Dynamic suburethral suspension with pedicled external oblique aponeurosis in the management of female urinary incontinence.

PURPOSE: Despite excellent postoperative continence with pubovaginal sling procedures, the resultant morbidities of de novo urgency and urinary obstruction due to sling tension remain valid concerns. The feasibility and outcome of dynamic suburethral suspension using bilateral strips of external oblique aponeurosis left attached medially to the anterior rectus sheath and joined beneath the urethra under no tension were determined. MATERIALS AND METHODS: Between May 1995 and April 1998, 25 women with stress urinary incontinence were evaluated and underwent a dynamic suburethral suspension procedure. All patients were followed annually with a 10-point questionnaire by an independent registered nurse who analyzed the results, complications and satisfaction outcome. RESULTS: At a mean followup of 26 months all patients (100%) were cured of stress incontinence. Associated urge incontinence due to detrusor overactivity persisted in 3 patients postoperatively and, thus, the overall postoperative cure/dry rate was 88% for the study group. Of the 18 patients with preoperative urgency 12 (66%) were cured postoperatively. De novo urgency developed in 1 patient after surgery. No patient had prolonged urinary retention. Overall 92% of the patients were satisfied with the outcome of surgery. CONCLUSIONS: This dynamic suburethral suspension procedure cured stress incontinence in the majority of patients with no resultant urinary obstruction. The mechanism of action is believed to work by providing a viable suburethral "backboard" of support and by dynamic lifting of the proximal urethra cradled by the fascial loop precisely at the time of abdominal strain. Pronounced urge incontinence due to detrusor overactivity is unlikely to benefit from suspension procedures.     

Sling transection of urethra: a rare complication

Common postoperative complications associated with suburethral sling procedures include voiding disorders and urinary retention, de novo development of detrusor instability, sling graft rejection and, rarely, erosion of the graft into the urethra. The authors present a case of a late postoperative complication of polytetrafluoroethylene graft erosion and partial transection of the urethra, with resultant acute urinary retention. A 50-year-old patient presented with acute urethral outflow obstruction due to sling graft erosion into the urethra nearly 2 years after she underwent a curative sling procedure for recurrent genuine stress incontinence. After relieving the acute urinary retention by inserting a suprapulic catheter under ultrasound guidance, the sling graft was accessed and removed. The urethral defect was repaired successfully. At follow-up 5 months later, the patient was continent subjectively and by urodynamic criteria, with no voiding abnormalities. Although erosion of the sling graft into the urethra and transection of this structure is a rare complication after a sling procedure, it should be considered in the patient who experiences progressive voiding difficulties, has transvaginal urinary leakage, and/or cannot be catheterized transurethrally. Expedient relief of the urinary retention and outflow obstruction is necessary, as well as careful surgical reconstruction of the urethra. To minimize the development of this complication we recommend plication of paraurethral connective tissue in the midline beneath the sling graft, and placement of minimal tension on the sling.     

Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery

Objective The aims of this study are to report the efficacy of retropubic urethrolysis, vaginal urethrolysis, and cutting of synthetic suburethral slings in treating postoperative voiding dysfunction that occurs after anti-incontinence surgery and to report the recurrence rate of stress urinary incontinence (SUI).Methods All patients from January 1996 to October 2003 who presented with voiding dysfunction following an anti-incontinence procedure and who subsequently underwent either retropubic urethrolysis, vaginal urethrolysis, or synthetic suburethral sling takedown were included in the study. Pre- and postoperative irritative symptoms (urinary frequency or urgency), obstructive symptoms (hesitancy, voiding difficulty, and incomplete emptying), and stress urinary incontinence symptoms were obtained in a standardized fashion. The Incontinence Impact Questionnaire and Urogenital Distres Invetory quality of life (QOL) questionnaires were also obtained to objectify these symptoms. Other objective postoperative analysis included simple uroflowmetry, measurement of postvoid residual (PVR), and simple or subtracted cystometry.Results Forty-four patients were included in the study (suburethral sling takedown=14, vaginal urethrolysis=20, and retropubic urethrolysis=10), 77% of whom had objective follow-up. Preoperatively, 31 patients (70.5%) had irritative symptoms, 41 (93.2%) had obstructive symptoms, and 6 (13.6%) had symptoms of stress urinary incontinence (SUI), while postoperatively, these symptoms were found in 30 (68.2%), 11 (25.0%), and 18 (40.9%), respectively. Postoperatively, 6 patients (17.6%) had a PVR> 100 cc, 5 patients (14.7%) had a bladder contractions, and 16 patients (47.1%) demonstrated the sign or diagnosis of (SUI). Additionally, there was a statistically significant improvement in both QOL questionnaires.Conclusions Various surgical approaches may be used to treat voiding dysfunction following an anti-incontinence procedure. Following a vaginal or retropubic urethrolysis or takedown of a synthetic suburethral sling, obstructive symptoms are likely to improve, irritative symptoms may remain unchanged, and almost half will develop recurrence of SUI.     

The YAMA UroPatch sling for treatment of female stress urinary incontinence: a pilot study

BACKGROUND AND PURPOSE: We report our initial experience using a new suburethral sling made from bovine pericardium for the treatment of urinary incontinence. To prevent rolling and curling of the sling, a unique anti-roll clip is incorporated into the UroPatch. In addition, the sling has a series of perforations that create evenly distributed tissue integration and avoid delayed seroma or hematoma formation, thereby reducing the risk of sling rejection, infection, and erosion. PATIENTS AND METHODS: Twenty-two female patients underwent suburethral sling procedures using the UroPatch. All patients demonstrated urethral hypermobility, intrinsic sphincteric deficiency, or both. Five patients had previous surgical treatment for urinary incontinence. RESULTS: All operations were completed successfully. No intraoperative or postoperative complications occurred. There was no evidence of local or systemic reaction to the UroPatch in any of the patients. With a mean follow-up of 20 months, sling rejection, erosion, or infection has not been demonstrated, and no sling required removal to date. Urinary incontinence was corrected in all but one case. CONCLUSION: The results of this pilot study suggest that the UroPatch is a promising alternative to current slings for the treatment of female urinary incontinence.     

In situ anterior vaginal wall sling formation with preservation of the endopelvic fascia for treatment of stress urinary incontinence

The indications for sling procedures have evolved and encompass patients with either intrinsic sphincteric deficiency (ISD), anatomic incontinence or both. We have refined a technique that can be performed in a minimally invasive fashion with low attendant morbidity to provide a reproducible method of sling formation. Twenty patients with stress urinary incontinence underwent the in situ sling (ISS) with bone fixation. Subsequent evaluation at 24–29 months (mean =26.2 months) revealed that 95% of patients were cured. No recurrent cystoceles, paravaginal defects or significant detrusor instability have been noted. Urinary retention appeared transiently in only 3 patients and resolved in under 3 weeks. We feel the in situ sling with bone fixation provides a safe and effective means of management for stress urinary incontinence. Furthermore, the reduced surgical dissection may minimize the incidence of postoperative ISD and recurrent paravaginal defects that may accompany more traditional needle suspension procedures.Editorial Comment: The authors present an interesting approach to the performance of a suburethral sling procedure which utilizes the anterior vaginal mucosa beneath the urethra as the supportive section of the sling, similar to the Raz vaginal wall sling technique. The patch is secured with sutures which are transported to the suprapubic site and attached to the symphysis pubis with bone anchors. Whether this procedure will provide longterm support to the urethrovesical junction will only be judged with time, and with prospective studies with pre-and postoperative objective urodynamic evaluation. The present study is truly an initial report of the technique, performed on a small group of patients with genuine stress incontinence or intrinsic sphincter deficiency with or without urethrovesical junction hypermobility. One major concern with any technique utilizing bone anchors attached to sutures coming from the perivaginal tissue following dissection of the anterior vaginal compartment is the potential risk of introducing pathogens to the bone, with resultant osteitis pubis or osteomyelitis.     

Outcomes of autologous fascial slingplasty procedure for treating female urinary incontinence

The aims of this study were to compare the pre- and postoperative urodynamic findings of the suburethral autologous rectus fascial sling procedure and to determine patient satisfaction with the procedure by telephone interviews. Eight-four female patients with urodynamic stress incontinence completed a multi-channel urodynamic study and pad test before and after the operation. Subjective and objective satisfaction were also recorded. Significant changes were noted in the stress maximal urethral closure pressure, pad test, voided volume, and peak flow rate (P < 0.05). The success rate was about 94%, and subjective satisfaction was about 72%. The most common complication was transient urinary tract infections. The suburethral sling resolved 50% of detrusor overactivity (DO), but de novo DO was 24%. The procedure combined with anterior colporrhaphy corrected or improved 97% of anterior vaginal wall prolapses (> or =stage II). This retrospective study demonstrates that suburethral autologous facial slingplasty has a high cure rate, high patient satisfaction, and is a less complicated procedure. It can also correct and prevent a recurrence of anterior vaginal wall prolapse when combined with anterior colporrhaphy.     

Urethral reconstruction after erosion of slings in women

PURPOSE OF REVIEW: The purpose of this review is to summarize the recent peer review literature and provide expert opinion about the diagnosis and treatment of sling erosions. RECENT FINDINGS: The incidence of sling erosion depends partly on the composition of the sling. Synthetic slings, particularly those made of woven polyester and other tightly woven material erode 15 times more often than autologous, allograft and zenograft slings. The presenting symptoms for all types of sling erosions include urinary retention, urge and mixed incontinence, but synthetic sling erosions often present with additional symptoms, including vaginal discharge, vaginal pain/pressure, suprapubic pain, and recurrent urinary tract infection. The diagnosis is made by cystoscopy. For synthetic sling erosions, it is generally agreed that the entire sling and as much foreign material (bone anchors, screws and sutures) as possible should be removed and the urethra repaired. For non-synthetic sling erosions, incision or partial excision of the sling and urethral closure suffices. The success rate for urethral repair ranges from 89 to 100%, but unless an anti-incontinence procedure is performed concomitantly, the likelihood of postoperative incontinence ranges from 44 to 83%. When synchronous anti-incontinence surgery was performed the anatomical success rate was 96% and the continence rate 87%. SUMMARY: Erosions of urinary slings are rare, but synthetic slings erode 15 times more often than non-synthetic slings. The anatomical success rate is very high after a single operation, but unless a concomitant anti-incontinence operation is performed, the likelihood of postoperative sphincteric incontinence is very high.     

Complications of silicone sling insertion for stress urinary incontinence

PURPOSE: A pilot study was performed to evaluate the suitability of silicone as a substance for suburethral sling placement. Using rectus sheath for sling placement can be time-consuming and can result in increased morbidity. Adjustable synthetic materials of consistent strength are available. Silicone has previously been used successfully and was chosen for this trial. MATERIALS AND METHODS: Slings were inserted in 7 women with stress urinary incontinence. Of the patients 3 had a history of continence surgery and presented with reduced vaginal mobility, and 2 who had not previously undergone continence surgery had intrinsic sphincter deficiency. RESULTS: In all women stress urinary incontinence was subjectively cured. However, after 7 slings were inserted the study was terminated due to a high complication rate related to erosion and sinus formation in 5 slings which were removed. Complications developed immediately or up to 11 months after sling insertion. Continence was maintained in 4 of the 5 women after the slings were removed. CONCLUSIONS: Silicone is an inappropriate material for suburethral sling placement when used as described in our cases, caution should be exercised when placing silicone slings at this site.     

Biomechanics of Urinary Stress Incontinence Surgery – Theory of the Non-Permanently Acting Suburethral Supportive Structure

This biochemical study of the lower urinary tract as it relates to urinary continence and incontinence is based on the morphotopographic results of radiological, autopsy and surgical investigations in the period 1966–1968. The process of urinary continence is simply explained by the application of universal hydromechanical laws, which demonstrated that continence during straining results from compression of the urethra over a suburethral resistant structure. Compression occurs during dorsocaudal physiologic displacement of the urethrovesical complex in conditions of increased intra-abdominal pressure. The theory of a non-permanently acting suburethral support is based on these results and represents the essential principle of urinary stress incontinence surgery, namely, that surgery should create a suburethral resistance over which the proximal urethra is compressed during increased intra-abdominal pressure.  Such suburethral resistance may be created via the vaginal or the abdominal routes, using autogenous or heterogeneous tissue. A critical analysis of different surgical techniques and how they achieve the demands of this theory is presented. In this context two orginal surgical procedures incorporating the best biomechanical features are elaborated: slinglike colposuspension via the abdominal route, and suburethral duplication of the anterior vaginal wall by the vaginal route. The aim of this paper is to present the biomechanical study of urethrovesical phenomena playing a role in urinary continence and the pathogenesis and surgery of stress incontinence in light of our theory. Our personal experience with 1836 surgical procedures between 1968 and the end of 1997, encompassing 1056 slinglike colposuspensions and 780 suburethral duplications of the vagina, gives practical support to our concepts.     

Voiding function after a modified no-tension pubovaginal sling

Voiding dysfunction following sling procedures for correction of genuine stress urinary incontinence (GSI) is a frequently reported complication. This study sought to determine if voiding dysfunction could be reduced by eliminating sling tension against the urethra. Participants were diagnosed with GSI and randomized to one of two surgical groups. One received a conventional suburethral sling and the other received a modified sling placed at the mid-urethra without tension. Voiding trials after surgery monitored for voiding dysfunction. Multichannel urodynamic studies were performed pre- and post-operatively. Cure rates for GSI were similar for the two groups (91.7 vs. 88.5%). The 27 patients in the modified group voided an average of 5 days earlier than the 21 patients in the conventional group. Conventional group patients were more likely to have urinary retention (125 vs. 49 cc, p=0.03). The modified group had a lesser change in average closure pressure following surgery. Results suggested a higher increase in urethral resistance in the conventional group (0.72 vs. 1.88 cm H₂O ml^-2 sec²). No differences were seen in symptomatic urinary urgency or urge incontinence following surgery. This study demonstrated a no-tension sling at the mid-urethra to afford equivalent cure of GSI with significant reduction of voiding dysfunction.Editorial Comment: Due to a significant rate of postoperative voiding dysfunction that is associated with pubovaginal slings, the authors developed two important modifications of the conventional sling to address this complication—midurethral positioning of the sling and the avoidance of tension on the sling arms based on maintenance of the intraoperative resting Q-tip angle. The authors performed a well-designed prospective randomized study comparing voiding function, cure rates and urodynamic indices following a conventional sling consisting of a polytetrafluoroethylene graft and a no-tension modification sling. They found similar cure rates for each group, but decreased obstructive symptoms, a faster return to normal voiding and decreased PVRs in the modified sling group, which was further supported by urodynamic parameters. The study was ended early due to a clinically significant difference that was found in voiding function between the groups. Interestingly this study was initiated in 1991, and these two modifications have since been popularized with the recent success of tension-free midurethral slings. However, despite these changes that have been incorporated in these slings, voiding dysfunction, as studies have shown, is still a complication.     

Vaginal erosion after hybrid midurethral sling placement

Midurethral polypropylene slings are popular procedures for the treatment of stress urinary incontinence in women. Several commercially manufactured sling kits are available that use proprietary monofilament polypropylene mesh placed between the vaginal wall and midurethral segment. The BioArc sling system is a hybrid sling system that uses polypropylene mesh for fixation and autologous fascia for suburethral support. We report what we believe to be the first case of vaginal erosion after midurethral sling placement using this hybrid system.     

Erosion of a fascial sling into the urethra

When synthetic materials are used for the construction of pubovaginal slings, urethral erosions may occur. This complication has not been reported with fascial slings. We present a case of a 34-year-old woman who underwent a pubovaginal sling procedure using rectus fascia. After 10 weeks of urinary retention, urethroscopy identified an erosion of the sling at the midurethra. Surgical revision restored normal voiding without recurrent stress incontinence. Although urethral erosions have been reported with synthetic suburethral slings, this case suggests that erosions can also occur with fascial slings. Careful positioning and minimal tension on the sling arms may minimize this risk.     

Management of the complications of the synthetic slings

PURPOSE OF REVIEW: The aim of this article is to review the last year's literature on the management of vaginal erosion and obturator abscess with suburethral tapes in the treatment of female urinary incontinence. RECENT FINDINGS: During the past decade suburethral tapes have been approved in Europe for minimally invasive treatment of stress urinary incontinence. Consensus is, however, lacking regarding the material best suited for this surgery. Although the success rates with synthetic materials have been, in general, good, the risk of vaginal extrusion and urethral erosion is considerably greater, ranging from 0.2 to 22%. We report diagnosis and management of complications occurring after this procedure. The presenting symptoms, physical findings, diagnostic procedures, surgical treatments, and outcomes are analyzed. Pain, vaginal discharge, bleeding, recurrent urinary tract infections, and/or persistent stress urinary incontinence are suspected symptoms of vaginal erosion. All vaginal erosions are usually detected by physical examination; in cases of suspected pelvic abscess, magnetic resonance imaging is performed. Total tape removal is recommended in the majority of cases; however, patients have recurrence of incontinence. SUMMARY: Urogenital tract erosion and pelvic abscess are significant complications of suburethral tape; immediate symptom relief is expected after removal of the eroded sling.     

Pubic bone suburethral stabilization sling: laparoscopic assessment of a transvaginal operation for the treatment of stress urinary incontinence

The objective was to examine laparoscopically the mechanism and precision of a new transvaginal method for fixation of a suburethral stabilization sling prosthesis designed for the treatment of recurrent stress urinary incontinence. Nine patients with recurrent stress urinary incontinence after previous anti-incontinence surgery underwent transvaginal placement of a pretrimmed 2.0 x 5.5 cm synthetic pubic bone suburethral stabilization sling prosthesis with pubic bone anchors. Before the sling fixation sutures were tied, the space of Retzius was opened laparoscopically with an operative laparoscope, and sling placement was assessed. Patients were followed up postoperatively at routine intervals. All nine procedures were accomplished uneventfully and as planned. Laparoscopic surveillance demonstrated that bone anchor placement by palpation was accurate and that low-tension sling fixation necessitated 2.0- to 2.5-cm suture bridges between the lateral sling edges and the pubic bone anchors in all cases. Continence was restored in all cases; two patients experienced mild, transient urinary retention; one patient experienced transient detrusor instability. No significant postoperative complications were noted. Low-tension pubic bone suburethral sling placement requires suture bridging of approximately 2.0 to 2.5 cm per side when a prosthesis 5.5 cm long is employed.     

The evolution of midurethral slings

Use of urethral slings in the treatment of incontinence started in the early 20th century. An evolution in understanding the pathogenesis of urinary incontinence led to development of the midurethral sling, which was designed to replace the natural suburethral vectors of support, as described in the integral theory. Since the introduction of tension-free vaginal tape in 1995, multiple other commercially available types of midurethral sling have been introduced. In general, these sling types share the common characteristics of using a thin, type I synthetic mesh inserted at a midurethral level and applied without tension. The midurethral sling procedure has subsequently undergone multiple technical modifications, predominantly alterations to the technique and route used for sling insertion. Despite the variety in techniques, available evidence suggests that all sling types provide efficacious and durable outcomes. Several adverse effects have been reported that are specific to certain techniques, and include the risk of vascular, enteric or nerve injury, lower urinary tract injury, urinary retention or voiding dysfunction, and vaginal erosion. Nonetheless, the midurethral sling provides a safe surgical option overall, and represents a notable advance in the treatment of stress urinary incontinence.     

Urethral erosion of tension-free vaginal tape presenting as recurrent stress urinary incontinence

The suburethral sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence. Erosion of the mesh into the urethra is rare, usually presenting with hematuria, pain, voiding dysfunction or urge incontinence. A patient with stress incontinence was treated with a TVT suburethral sling. One month later, symptoms of recurrent stress incontinence developed. Cystourethroscopy revealed urethral mesh erosion. Surgical removal involved cystourethroscopic-assisted transurethral resection of the mesh, followed by vaginal dissection and periurethral withdrawal. Urethral mesh erosion should be considered in a patient who presents with atypical symptoms after being treated with a suburethral sling. It is important to obtain a detailed history and have a high clinical index of suspicion for erosion. Careful and comprehensive urethroscopy, in addition to cystoscopy, should be a mandatory part of the TVT procedure. Further study is needed to determine the optimal technique for mesh removal.Abbreviations TVT Tension-free vaginal tape     

Erosion of woven polyester pubovaginal sling

PURPOSE: Various materials have been used for pubovaginal slings to correct female stress urinary incontinence. Use of synthetic materials provides a theoretical advantage in that no graft harvesting is necessary. Major risks of synthetic material use are erosion and infection of the sling. We report on erosion of woven polyester slings treated with pressure injected bovine collagen (ProteGen) which required removal. MATERIALS AND METHODS: Office records of patients who had ProteGen slings removed at 5 centers during the last 24 months were retrospectively reviewed. Presenting symptoms, interval between sling placement and removal, subsequent procedures and continence status following sling removal were evaluated. RESULTS: A total of 34 women required removal of the polyester sling secondary to erosion, infection or pain. The most common presenting complaints were delayed vaginal discharge in 21 patients (62%), vaginal pain or pressure in 21 (62%), suprapubic pain in 11 (32%) and recurrent urinary tract infection in 5 (15%) at a mean of 7.95 months (range 1 to 22) after sling placement. Of the patients 17 (50%) had vaginal erosion only, 7 (20%) isolated urethral erosion and 6 (17%) urethrovaginal fistulas. In 4 patients no erosion was obvious but slings were removed secondary to vaginal pain. Before sling removal 16 patients (47%) were totally dry, 13 (38%) had some degree of urinary incontinence and 3 (8%) had retention. Following sling removal 7 patients (20%) remained dry, 25 (74%) had mild to severe stress urinary incontinence with or without urgency and urge incontinence, and 2 (6%) are pending followup. CONCLUSIONS: Woven polyester slings treated with pressure injected bovine collagen are prone to erosion. Although the ProteGen sling was recalled in January 1999, patients who have had the sling placed must be followed closely.     

Male perineal sling with autologous aponeurosis and bone fixation - description of a technical modification

Post-prostatectomy urinary incontinence is an uncommon complication of adenomectomies, occurring in approximately 1% of cases and being more frequent following radical prostatectomies. There is a significant implication in the quality of life for these patients. The surgical techniques employed for its treatment are the implantation of an artificial sphincter, peri-urethral injections and suburethral slings. Considering the low efficacy of peri-urethral injections and the high cost of artificial sphincters, we present in this work a technical modification of the suburethral sling, whose preliminary results are satisfactory. The fundamental modification in this technique is due to the replacement of the synthetic material usually employed for making the sling for autologous tissue, constituted by an aponeurotic strip taken from the rectus muscle of abdomen. This modification aims to minimize risks of urethral erosion that, despite it was not described in this population due to the use of synthetic materials, is a possibility when facing the tension that is used over the bulbar urethra. In addition to such aspects the autologous aponeurosis does not have a cost except for a short prolongation of the surgical act.     

四种吊带手术经腹壁或闭孔固定治疗女性压力性尿失禁的效果比较

目的:探讨四种吊带手术经腹和闭孔途径治疗女性压力性尿失禁的效果.方法:采用人工合成材料的吊带经腹壁固定方式(TVT和IVS技术)治疗女性压力性尿失禁患者23例;用经闭孔固定方式(TOT和TVTO技术)治疗女性真性压力性尿失禁患者16例.并进行疗效比较.结果:绝大多数患者均排尿通畅,无尿失禁复发.但TVT组中有1例排尿不畅,3个月后剪断吊带后变为轻度尿失禁;有1例术中膀胱穿孔,术后停留导尿管1周.结论:用四种吊带手术治疗女性真性压力性尿失禁安全、微创和有效.经闭孔固定技术和用经腹壁固定技术这两种方法各有自己的优缺点.