盆底生物反馈联合电刺激治疗女性压力性尿失禁

目的探讨盆底生物反馈联合电刺激治疗女性压力性尿失禁（stress urinary incontincnce,SUI）和压力/急迫混合性尿失禁（mixed urinary incontinence,MUI）的临床效果。方法2006年5月-2007年6月对40例轻中度女性尿失禁患者（SUI 22例,MUI 18例）,采用生物反馈治疗仪进行盆底生物反馈联合电刺激的训练治疗,治疗时间20-30 min,3次/周,疗程2个月。结果40例均获随访,平均8.9（3-14）个月。治愈14例（35.0%）,改善16例（40.0%）,无效10例（25.0%）,总有效率为75.0%;其中SUI有效率为77.3%（17/22）,MUI有效率为72.2%（13/18）。除少数患者插入探头时有轻微不适感外,无其他明显不适,无阴道感染等不良反应发生。但有5例治疗有效的患者症状复发。结论盆底生物反馈联合电刺激治疗女性轻中度SUI或MUI安全有效、治愈率较高。治疗后如能继续坚持Kegel操盆底肌锻炼有助于预防尿失禁的复发。     

The 7‐year outcome of the tension‐free vaginal tape procedure for treating female stress urinary incontinence

OBJECTIVE

To evaluate the long‐term results and predictive risk factors for efficacy after the tension‐free vaginal tape (TVT) procedure for treating female stress urinary incontinence (SUI).

PATIENTS AND METHODS

Inall, 306 women (mean age 50.7 years, sd 8.7) who had a TVT procedure for SUI were selected and followed ≥7 years (mean 92.3 months, range 84–110) after surgery. We analysed the long‐term results, the variables predictive of cure rates, and patient satisfaction.

RESULTS

The overall 7‐year cure rate was 84.6%, with a satisfaction rate of 69.3%. The cure rates were lower in patients with high‐grade SUI (50% in grade III, 82.8% in grade II and 90.7% in grade I; P < 0.001). On multivariate analysis, there were no independent risk factors related to cure rate, and urgency was the only factor independently associated with patient satisfaction (P = 0.008; odds ratio 2.47). Seventy‐one patients (23.2%) had complications at the 1‐month follow‐up after surgery, but only eight (2.6%) had complications at the 7‐year follow‐up, including mesh exposure in six and de novo urgency in two.

CONCLUSION

The absence of long‐term adverse events associated with the TVT procedure, and high subjective and objective 7‐year success rates with no independent predictive factors affecting the long‐term cure rate, make the TVT procedure a recommendable surgical treatment for female SUI.     

自体筋膜尿道悬吊治疗女性压力性尿失禁的探讨

目的：探讨自体筋膜尿道悬吊术在女性压力性尿失禁治疗中的效果。方法：采用经耻骨上人路自体筋膜尿道中段悬吊术治疗女性压力性尿失禁,回顾性分析2000年2月～2007年12月采用该手术方式治疗28例女性压力性尿失禁患者的临床资料和治疗效果。结果：所有患者无耻骨后血肿形成,无尿道损伤;膀胱损伤1例,延长导尿管留置时间后治愈;28例患者术后拔除尿管均能自行排尿并满意控尿,6例患者出现不同程度不稳定膀胱症状,经对症处理缓解。随访9～21个月,平均15个月,无压力性尿失禁症状复发及排尿困难。结论：自体筋膜尿道悬吊术治疗女性压力性尿失禁简单易行,操作安全,损伤性较小,费用低廉。     

Short‐term assessment of a tension‐free vaginal tape for treating female stress urinary incontinence

OBJECTIVE

To evaluate the short‐term surgical complications and results of a tension‐free vaginal tape (TVT) system (TVT‐Secur^TM, Gynecare, Ethicon, Somerville, NJ, USA) in the treatment of female stress urinary incontinence (SUI).

PATIENTS AND METHODS

TVT‐Secur was applied to 107 women with SUI through a vaginal incision and left abutting the urethra. Postoperative pain, complications, de novo lower urinary tract symptoms, incontinence cure rate and the King’s Health Questionnaire (KHQ) score were evaluated.

RESULTS

The operative duration was 12 min; the mean pain score was 2.3 and only one patient had transient voiding difficulties. After a mean follow‐up of 15 months, 71% of the patients were dry and 14% improved. The KHQ scores decreased significantly for most subscores. Urgency appeared de novo in six patients (5.6%), and vaginal erosion required one TVT‐Secur explantation.

CONCLUSION

This study shows that TVT‐Secur is a simple and safe treatment for female SUI, but before recommending this sling as a first choice for treating SUI, TVT‐Secur must pass the test of time and comparative studies with conventional slings.     

TVT-O治疗女性压力性尿失禁长期疗效分析

目的 探讨由内向外经闭孔尿道中段无张力悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的长期疗效.方法 分析2004年8月至2006年8月应用TVT-O手术治疗68例女性SUI患者的临床和随访资料,探讨TVT-O术后至少6年的治愈率及常见并发症.结果 以尿失禁症状消失和咳嗽试验阴性定义为临床治愈,在TVT-O术后6周、1年和6年的治愈率分别是85.3％(58/68)、82.4％(56/68)和80.9％(55/68),差异无统计学意义(P＞0.05).术后排尿困难3例,新发尿急4例,大腿根部和腹股沟区疼痛13例,均行相关处理.术后复发3例,采用其他疗法.结论 TVT-O是治疗女性SUI的有效术式,其长期疗效持续稳定.TVT-O严重并发症少见,但术后腹股沟疼痛需引起高度重视.     

Abdominal Urethrocystopexy Using Fibrin Sealant. A Prospective Study of Long-Term Efficacy

Over the past decade efforts have been made to develop less invasive surgical treatment for female stress urinary incontinence (SUI). Abdominal urethrocystopexy with fibrin sealant combined with a couple of absorbable sutures has previously been reported as a promising method. This prospective observational study was aimed at evaluating the efficacy and safety of abdominal urethrocystopexy through a minilaparotomy using solely fibrin sealant (Tisseel) as the fixation glue. Forty-three women with objectively proven SUI were operated upon with this method. The subjective cure rates at 1 and 3 years’ follow-up were 72% and 55%, respectively. The corresponding objective cure rates were 64% and 60%. No serious major operative complications occurred. One patient had transient urinary retention for 3 months. Otherwise, micturition was established within a median 1 day (range 1–3 days) after the operation. The result of this pilot study indicates a cure rate lower than that obtained with the conventional abdominal Burch colposuspension. Thus the method cannot be recommended as a standard procedure for treatment of SUI.     

The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update

Six years ago, the inside–out transobturator tape TVT-O procedure was developed for the surgical treatment of female stress urinary incontinence (SUI) with the aim of minimizing the risk of urethra and bladder injuries and ensuring minimal tissue dissection. Initial feasibility and efficacy studies suggested that the TVT-O procedure is associated with high SUI cure rates and low morbidity at short term. A recent analysis of medium-term results indicated that the TVT-O procedure is efficient, with maintenance, after a 3-year minimum follow-up, of cure rates comparing favorably with those reported for TVT. No late complications were observed. As of July 2008, more than 35 clinical papers, including ten randomized trials and two national registries, have been published on the outcome of the TVT-O surgery. Results from these studies have confirmed that the TVT-O procedure is safe and as efficient as the TVT procedure, at least in the short/medium term.     

Placard-shaped in situ vaginal wall sling for the treatment of stress urinary incontinence

PURPOSE: To evaluate the efficacy of a simple and economic procedure using a placard-shaped in situ anterior vaginal wall sling for the treatment of stress urinary incontinence, with or without cystocele repair. METHODS: From July 2003 to July 2004, 14 female patients (mean age 45.21 years, range 37-57) were operated upon because of stress urinary incontinence (SUI) with the placard-shaped in situ anterior vaginal wall sling technique. The average follow-up period was 11 months (range 4-14.5 months). Twelve patients were operated primarily with this technique and only two patients had undergone previous surgeries for the treatment of SUI (one patient had had two previous surgeries and the other had had one previous surgery). In all patients urethral hypermobility or/and bladder prolapse were observed. Filling cystometry showed sufficient bladder capacity with no detrusor overactivity. RESULTS: No urinary retention was observed in any patient in the postoperative period. While 11 patients have 100% cure of incontinence, three patients started leakage of urine after 1-2 months after the operation (one patient had been operated upon twice before (and who was diabetic and obese) and two patients were primarily repaired by our technique). In two patients, suprapubic tenderness and redness were observed, and were treated by oral antibiotic and anti-inflammatory drugs. CONCLUSION: The placard technique is simple, cost-effective and has low incidence of urinary retention in the post-operative period. The success rate seems to be satisfactory and it can be applicable to patients who are primary cases of SUI with average body mass index. Yet longer term follow up and larger number of patients are needed before final conclusion can be drawn.     

改良的无张力尿道中段悬吊术治疗女性压力性尿失禁疗效观察

目的：观察改良的无张力尿道中段悬吊术（Tensionfree viginaI tape,TVT）治疗女性压力性尿失禁的效果。方法：采用改良的TVT治疗女性压力性尿失禁患者26例。结果：26例患者术后压力性尿失禁完全消失,平均手术时间36min,平均出血量45ml,术中未见膀胱损伤、大出血、血肿及神经损伤。结论：改良的TVT手术创伤小,悬吊疗效可靠,且价格低廉,易为患者接受。     

Long‐term outcome of tension‐free vaginal tape for treating stress incontinence in women with neuropathic bladders

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To evaluate the long‐term safety and efficacy of the tension‐free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction.

PATIENTS AND METHODS

Twelve women (mean age 53.3 years, range 41–80) with neuropathic bladder dysfunction and SUI confirmed by video‐cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro‐urologist between November 1997 and December 2000. The patient’s notes, clinical annual follow‐up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ‐7) were assessed during the long‐term clinical follow‐up for SUI, in addition to a health‐related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment.

RESULTS

The mean (range) follow‐up was 10 (8.5–12) years. Nine patients were using clean intermittent self‐catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow‐up, one patient had died (with failed TVT initially), and two were lost to follow‐up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow‐up.

CONCLUSIONS

In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long‐term outcomes.     

Long-term results of surgical treatment for female stress urinary incontinence

OBJECTIVE: To compare the long-term success rates of bladder neck suspension (BNS) and pubovaginal sling procedure in different types of female stress urinary incontinence (SUI) in order to identify appropriate treatment strategies for SUI. METHODS: A total of 157 women who received anti-incontinence surgery were followed-up for a mean period of 58.1 +/- 33.9 months. The surgical outcome was analyzed and was compared among the different types of SUI and among BNS and pubovaginal sling procedures. RESULTS: SUI was classified as type I in 16 patients, type II in 111 patients, and type III in 34 patients. Surgical procedures included Gittes BNS (n = 62), Raz BNS (n = 53), and pubovaginal sling procedure (n = 42). The total success rate was 77.1%, including a 38.2% cure rate and a 38.9% significantly improved rate. Analysis of the results revealed that type III SUI had the lowest success rate (67.6%), while the pubovaginal sling procedure had the best success (93.9%) and cure rates (54.8%). The success rates of BNS were significantly lower than that of pubovaginal sling in type III SUI, less favorable in type II SUI, but remained high in type I SUI. 75% of patients with treatment failure had recurrence within the fist postoperative year. CONCLUSIONS: In this series of patients, the long-term cure rates of anti-incontinence surgeries are not satisfactory. BNS procedures had satisfactory results only in type I SUI while the pubovaginal sling procedure had better results in both types II and III SUI. The pubovaginal sling procedure might have better long-term results in the treatment of all types of SUI.     

Transurethral polydimethylsiloxane implantation: a valid option for the treatment of stress urinary incontinence due to intrinsic sphincter deficiency without urethral hypermobility

PURPOSE: In this study we evaluated the 5-year followup results of periurethral polydimethylsiloxane (PDMS) injection for female stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) without hypermobility of the vesicourethral junction. MATERIALS AND METHODS: A total of 61 female patients with ISD were enrolled in this prospective, observational study. Preoperative and postoperative assessment included a standardized urogynecologic history with questions regarding urinary function, urogynecologic and neurological physical examination, and urodynamic assessment. All patients underwent periurethral PDMS injection. Patient followup was performed 1, 6, 12, 24, 36, 48 and 60 months after surgery. RESULTS: At 60 months after injection the SUI cure rate was 18%, the improvement rate was 39% and the failure rate was 43%. The success rate was 57%. Of the patients 45 (74%) subjectively improved with respect to the severity of urinary incontinence. No postoperative early complications were found. At 60 months of followup only minor complications were reported (11%). CONCLUSIONS: Careful patient selection by optimal diagnostic tools are essential for maximizing the results of urethral bulking agent therapy. PDMS injection in women with SUI due to ISD with limited urethral mobility is a valid, minimally invasive procedure.     

Future treatment for the female stress urinary incontinence

Stress urinary incontinence (SUI) is a major urologic health problem and the number of patients with SUI will rise dramatically as the population of elderly people continues to increase in Japan. This condition causes unnecessary and detrimental psychological distress, social isolation, and public expense for care. Surgery remains the cornerstone of treatment for female SUI and also in those who have failed to improve with conservative measures. Many surgical procedures, however, have been described with varying degree of success. The ideal surgical treatment for this disease should be effective in QOL improvement, minimal invasive and durable for the long-term. Based on a new understanding of the pathophysiology of SUI as well as the development of surgical techniques and devices, mid urethral sling operations such as TVT (tension-free vaginal tape) have become widely used and they provide significant short-term and long-term cure rates. However, perioperative complications, including serious problems like bowel, vascular and bladder injuries have been reported. Most complications are related to blind trocar passage in the retropubic space. The alternative procedure transobturator procedure was developed to minimize these complications, in which tape is introduced through the obturator foramen. This technique provides high short-term cure rates, similar to those achieved with TVT, but with fewer complications. A number of injectables have been used for the treatment of SUI, including collagen, coated-beeds and Teflon. Although injectable treatment is convenient and minimally invasive, efficacy and durability are lower than other surgical procedures. Modification by tissue-engineering techniques using autologous stem cells or precursors of mature cells showed regeneration and reconstitution of urinary sphincteric function. In the future this strategy may be an attractive therapy for SUI. The choice of operation should be tailored to suit each individual case based on the clinical and urodynamic findings, as well as the age and the expectations of treatment outcome.     

Are the outcomes of transobturator tape procedure for female stress urinary incontinence durable in long-term follow-up?

Purpose

To evaluate long-term cure rates and late complication rates after treatment for female stress urinary incontinence (SUI) with transobturator tape (TOT) procedure and to compare the outcomes of 1st year versus 5th year.

Methods

We analyzed 138 women who underwent TOT procedure for pure SUI and mixed urinary incontinence in two institutions during the time period of June 2005–May 2008 retrospectively. We used two kinds of polypropylene monofilament tapes (Heine Medizin^®urethral support system, Germany and I-STOP^®CL Medical, France) for the standard outside-in TOT in similar numbers. All patients were evaluated with pelvic examination including cough stress test and International Consultation on Incontinence Questionnaire-Short Form at 3 and 12 months and annually. Our primary outcome measures were rates of objective cure, subjective cure, patient satisfaction and failure for long-term follow-up.

Results

The objective cure, subjective cure and patient satisfaction rates of the 126 women at 1 year were 89.6, 86.5 and 92 % respectively. During 5-year follow-up, objective cure rate was stable with 87.3 % rate (p = 0.554), whereas subjective cure and patient satisfaction rates were decreased to 65.9 and 73 %, respectively (p = 0.001). Complications are reported according to the Clavien–Dindo classification with Gr I 14.3 %, Gr II 64.3 %, Gr IIIa 7.1 % and Gr IIIb 14.3 %.

Conclusions

TOT procedure is an effective minimal invasive procedure with satisfactory results for female SUI in short term. Although recovery in SUI symptoms was stable during 5-year follow-up, subjective cure and patient satisfaction rates decreased significantly due to urge urinary incontinence symptoms.     

Prospective analysis of patients treated with a distal urethral polypropylene sling for symptoms of stress urinary incontinence: surgical outcome and satisfaction determined by patient driven questionnaires

PURPOSE: We evaluated the safety and efficacy of the distal urethral polypropylene sling for stress urinary incontinence using patient self-assessment by questionnaires. MATERIALS AND METHODS: We performed a prospective study of all consecutive patients who underwent a mid distal urethral sling procedure between November 1999 and February 2002. Surgical outcome was determined by symptom, bother and quality of life questionnaires completed by the patients. The physicians were blinded to patient responses. These outcomes were compared to the SEAPI determined by the physician and to physical examination findings. RESULTS: There were 301 patients, of whom 2.3% required treatment for persistent stress urinary incontinence (SUI) after the polypropylene sling procedure. In the 92 patients with a minimum followup of 12 months the objective cure rate was 92%. The patient determined subjective success rate (cure and improved greater than 50%) was 89%. On questionnaires only 69% of the patients reported no symptoms of SUI under any circumstance and the same number reported never being bothered by SUI. The physician determined SEAPI overestimated patient self-reported symptoms by 10% to 50% depending on the symptom. CONCLUSIONS: The polypropylene sling represents an inexpensive, safe and simple alternative treatment for patients with stress urinary incontinence. The procedure provides high objective and physician determined cure rates but a lower patient self-reported subjective cure rate. Patient self-assessment of symptoms, bother and quality of life should be an integral part of the outcome of stress urinary incontinence surgery.     

经闭孔无张力尿道中段吊带术联合阴道前壁修补术治疗女性压力性尿失禁

目的 评价经闭孔无张力尿道中段吊带术(TVT-O)联合阴道前壁修补术治疗合并阴道前壁脱垂的女性压力性尿失禁(stress urinary incontinence,SUI)的效果.方法 行TVT-O联合阴道前壁修补术治疗合并阴道前壁脱垂的女性压力性尿失禁18例.术后随访12个月,进行主观治疗结果及术后远期并发症的调查.术后12个月时,复查盆腔器官脱垂定量分度法(POP-Q)分期、尿流率、性生活质量评分(PISQ-12).结果 尿失禁主观治愈率为88.9%(16/18),主观改善率为11.1%(2/18).4例阴道前壁脱垂复发(术前Ⅲ期3例,Ⅱ期1例,术后均为Ⅰ期),11名有规律性生活的患者PISQ-12评分术前术后分别为27.5±4.4和31.2±6.1(P＜0.05).结论 TVT-O联合阴道前壁修补术治疗合并中度阴道前壁脱垂的女性压力性尿失禁简便易行,疗效可靠,对患者性功能无不利影响.     

Urethral injection for stress urinary incontinence: long-term results with dextranomer/hyaluronic acid copolymer

Urethral injection is a convenient, minimally invasive means of treating stress urinary incontinence (SUI). We present long-term follow-up data from 20 patients originally recruited in 1994–95 (mean age 67 years) to receive urethral injection with dextranomer/hyaluronic acid (Dx/HA) copolymer. The majority of patients had failed previous therapy for SUI. If the first injection was unsuccessful, up to two further injections were offered. Only 3 patients (15%) failed to show a response to treatment. Sixteen women were reassessed during 2001 (4 had died of causes unrelated to the study treatment). A sustained response throughout the follow-up period was reported in 9/16 patients (57%), with incontinence recurring in just 4 (25%). None of the 7 patients with persistent or recurrent incontinence were cured by subsequent treatments, including surgery. In conclusion, urethral injection with Dx/HA copolymer offers promising long-term efficacy in the treatment of SUI, regardless of old age or failure to respond to previous therapy.Abbreviations SUI Stress urinary incontinence - VUR Vesicoureteral refluxEditorial Comment: These investigators present long-term follow-up on a newer periurethral injectable material, dextranomer/hyaluronic copolymer, for stress incontinence. The limited sample size of 20 patients with only 13 patients evaluable at 5 years, is one major disadvantage of this study; however, 69% of patients had a sustained response to urethral injection on post-operative subjective and objective testing which represents an improvement over existing injectable materials. Advantages of this material over some of the presently available agents include improved durability, lack of need for skin-testing and no reported autoimmune or migratory complications. Certainly, long-term data on more patients would be appropriate.     

TVT-O for the treatment of female stress urinary incontinence: results of a prospective study after a 3-year minimum follow-up

OBJECTIVES: Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown. We analyzed the 3-yr results of a prospective, observational study designed to evaluate the safety and efficacy of the TVT-O procedure. METHODS: Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual (PVR) measurement, and urinary symptoms and quality of life (QoL) questionnaires. Data were compared by means of the Wilcoxon matched pairs test. RESULTS: Between March 2003 and December 2003, 102 consecutive patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria underwent the TVT-O procedure; the latter was associated with pelvic organ prolapse treatment in 16 patients (15.7%). Three-year minimum follow-up (median, 40 mo) was available for 91 patients (89.2%). No erosion or persistent pain was noted. Four patients required tape release or section. Disappearance and improvement of SUI were observed in 88.4% and 9.3% of the patients, respectively. These cure rates were similar to those obtained 1 yr after the operation (p=0.55). Frequency and urge symptoms were improved at 3 yr (p<0.005). Whereas maximum flow rates were somewhat decreased (p=0.01), the severity of obstructive symptoms and PVR volumes were not statistically different (p=0.11 and p=0.32, respectively). Incontinence severity and QoL scale scores were largely better than preoperative ones (p<0.001) and did not differ from those reported at 1 yr (p=0.15 and p=0.08, respectively). CONCLUSIONS: The TVT-O procedure is a safe and efficient treatment of female SUI, with maintenance of high cure rates after a 3-yr minimum follow-up.     

Five-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence

OBJECTIVES: We evaluated the long-term efficacy and safety of a tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence (SUI) in a Korean population. METHODS: We included 134 patients (mean age, 52.3+/-9.3 yr) who underwent the TVT procedure for SUI in three institutions and followed for 5 yr (mean, 67.0 mo; range, 60-76 mo) postoperatively. We analysed voiding diaries and complete multichannel urodynamic studies preoperatively as well as cough stress tests, uroflowmetry, and questionnaires postoperatively. RESULTS: The overall 5-yr success rates (cure/improved) were 94.9% (76.9% and 18.0%, respectively), with an 86.6% patient satisfaction rate. Although the success rates between 1 and 5 yr were similar (97.7% vs. 94.9%), the cure rate decreased from 90.1% to 76.9% (p<0.001) at 5 yr. The 5-yr cure rate for mixed urinary incontinence (MUI) was 72.0%, which was not significantly different from pure SUI (78.0%, p>0.05). Maximal flow rate dropped from 25.9+/-10.3ml/s to 20.4+/-8.6ml/s at 1 mo postoperatively and recovered to 24.8+/-8.5ml/s at 5 yr. Complications included bladder perforation in 5 patients (3.7%), tape cutting or release in 11 (8.2%), and persistent suprapubic pain in 3 (2.2%). Urgency and urge incontinence improved in 46.7% and 48.0% of patients, respectively. CONCLUSIONS: TVT was an effective and safe procedure for SUI and MUI with high success rates in the long-term follow-up. It also improved concomitant overactive bladder symptoms and initially reduced postoperative urine flow, which recovered over time.     

Extraperitoneal laparoscopic urethropexy with Marlex mesh

OBJECTIVES: Extraperitoneal laparoscopic urethropexy (ELU) has recently been developed as a minimally invasive procedure for the treatment of female stress urinary incontinence (SUI). Use of the laparoscopic stapling device and Marlex mesh in the extraperitoneal space may allow for a technically easier procedure and shorter operative times compared with other laparoscopic techniques without compromising long-term efficacy. We present our initial results and 2.5-year interim analysis with this alternative method of laparoscopic urethropexy. METHODS: Twenty-four consecutive patients with urodynamically demonstrated genuine SUI underwent attempted ELU at a single institution from December 1994 to December 1995. Operative data were collected from the patient chart, and follow-up data were obtained by telephone interview. Treatment was considered successful if, at last follow-up, a patient was using one or fewer pads daily and would recommend the procedure to a friend. RESULTS: ELU was completed in 22 of 24 patients. In 1 patient with a prior history of pelvic surgery, the preperitoneal space was not accessible. Of the 22 patients, 20 were available for follow-up. The mean operative time was 69 minutes. There were no intraoperative complications. At initial follow-up (mean 10.5 months), 18 (90%) of 20 patients reported subjective cure of SUI (one or fewer pads daily). At a mean follow-up of 29 months (range 23 to 34), 16 (80%) of 20 patients had subjective cure of SUI. Six patients would not recommend the procedure to a friend, all of whom had de novo urgency and/or urge incontinence. Thus, using our strict criteria, ELU was successful in 14 (70%) of 20 patients at a mean follow-up of 2.5 years. No patient has had permanent urinary retention. CONCLUSIONS: ELU can be performed rapidly and safely in patients without previous pelvic surgery. De novo urgency incontinence may be problematic. Future analysis of this subset of patients will determine whether this procedure is durable in the long term.