Gore-tex sling urethral suspension in type III female urinary incontinence: Clinical results and urodynamic changes |
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Authors: | G A Barbalias E N Liatsikos A Athanasopoulos |
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Institution: | (1) Department of Urology, University of Patras, School of Medical, Patras, Greece |
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Abstract: | The authors prospectively evaluated 24 consecutive female patients with type III stress urinary incontinence, ranging in age
from 36 to 70 years (mean 55 years). All patients were operated upon and had a vesicourethral suspension by a Gore-Tex suburethral
sling. All were evaluated urodynamically 6 and 30 months after surgery. In this group of patients clinical cure of incontinence
was observed in 83.3% (20) and in the remaining 4 patients it was significantly improved. In 2 patients there was an erosion
of the urethra and the sling had to be removed 3.5 years later. Five other women remained dry but complained of occasional
irritative symptoms, and several urinary tract infections were recorded (2–3 per year), which were documented by positive
urine cultures. In the remaining 17 patients no erosion was observed and no irritative symptoms were reported. The urodynamic
evaluation revealed an excellent postoperative result both 6 months and 30 months after surgery.
EDITORIAL COMMENTS: This study reports the author’s experience with the use of the Gore-Tex suburethral sling procedure in
women with type III stress incontinence, excluding patients with urethrovesical junction hypermobility. Diagnosis is based
on videourodynamic criteria, as is postoperative follow-up and the definition of cure/failure. It is interesting that the
technique used specifically refrains from placing extensive tension on the sling, although extra sutures are placed attaching
the sling to ‘fascial tissue in the vicinity of the puboiliac bone’, even including the periosteum. Typically the use of a
sling procedure in patients with a fixed drainpipe urethra has been based on the obstructive characteristics of the sling,
rather than giving support to an already well supported urethrovesical junction. Previous reports have described postoperative
voiding dysfunction requiring intermittent self-catheterization, recurrent urinary tract infections, elevated postvoid residuals
and detrusor instability as possible consequences of ‘tight’ slings. Hints that these sequelae did occur in the study population
include the high incidence of urinary tract infections and detrusor instability (persistent and de novo), and the fact that
2 patients required removal of the sling because of erosion into the urethra. Although the authors report a significant cure
rate (84%) of stress incontinence, clearly this report again cautions against the use of slings in patients with ISD and a
well supported bladder neck. |
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Keywords: | Allogenic graft Gore-Tex sling Suburethral slings Type III stress urinary incontinence Urodynamic evaluation |
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