Introduction & Objectives: Modest long term success is one of the most disappointing issues facing patients undergoing anti-incontinence surgery.Herein we prospectively evaluated the long term results of a novel surgical modification in the treatment of female stress urinary incontinence(SUI).
Material & Methods: Twenty three female patients with mean age of 48.2 years(range:22-73),underwent anti-incontinence surgery to correct their SUI between Augusts 2006 and January 2008. All cases were primary except two patients had previous anti-incontinence surgery. Patients who had mixed incontinence (8 patients), where subjected to urodynamic evaluation and any patient who was documented to have urodynamically overactive bladder was excluded. In-situ anterior vaginal wall sling, reinforced with equi-size monofilament polypropylene tape, was used as an anti-incontinence surgical procedure. The mean follow up period was 30.2 months (range:24-38).
Results: The surgical technique was successful in twenty two 95.65% patients as twenty of them were cured and two patients showed clinical improvements. Only one patient 4.35% did not benefit from the surgery (64-year-old, diabetic, BMI= 44.98).Urinary retention was observed in one patients 4.34% which was resolved after decreasing the tension of suspension sutures. Vaginal mesh erosion was found in two patients 8.69% during the gynecological examination in the first month postoperatively, one of them had early sexual intercourse. Both of these patients suffered only from minimal discomfort during sexual intercourse and the patients refused surgical intervention and conservative approach (watchful waiting) was applied. No postoperatively significant post-voiding residue was detected. Postoperative urgency without urge incontinence was observed in two patients in the early post operative period which was resolved after temporary anti-cholinergic therapy for three weeks. Non of the patients showed suprabupic discomfort or pain due to fixation of suspension sutures with symphysis pubis, neither during the physical examination nor during daily physical activities.
Conclusions: Cost-effectiveness and low risk of urethral erosion, due to the presence of intervening vaginal mucosa, are important considerations of this technique. Long term success is expected, because relaxation of non-tension free suspension sutures and dislocation of midurethral sling are less likely.
Purpose Modest long-term success is one of the most disappointing issues
facing patients undergoing anti-incontinence surgery. Herein we
introduce a novel surgical modification of the vaginal sling to address
the mechanisms that may lead to a reduction in the success rate at the
long-term follow-up.
Materials and Methods Twenty-three female patients with mean age of 48.2 years (range,
22-73 years) underwent anti-incontinence surgery to correct their stress
urinary incontinence (SUI) between August 2006 and January 2008. The in
situ anterior vaginal wall sling, reinforced with equi-size
monofilament polypropylene tape, was used as an anti-incontinence
surgical procedure. The mean follow-up period was 30.2 months (range,
24-38 months).
Results The surgical technique was successful in 22 patients (95.65%); 20 of
them were cured and 2 patients showed clinical improvements. Urinary
retention was observed in one patient (4.34%), which was resolved after
decreasing the tension of the suspension sutures. No significant
post-voiding residue was detected postoperatively.
Conclusions Cost-effectiveness and a low risk of urethral erosion, due to the
presence of intervening vaginal mucosa, are important advantages of this
technique. Long-term success is expected, because relaxation of the
non-tension-free suspension sutures and dislocation of the midurethral
sling are less likely.