How To Achieve Long Term Success In The Treatment of Female Urinary Stress Incontinence? Novel Modification on Vaginal Sling

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Journal Title, Volume, Page: 
Eur Urol Suppl 2010;9(6):567
Year of Publication: 
Mahmoud Mustafa
Department of Urology, Osmaniye State Hospital, Osmaniye, Turkey
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Wadie B.S.
Urology and Nephrology Center, Dept. of Urology, Mansoura, Egypt
Horuz R.
Osmaniye State Hospital, Dept. of Urology, Osmaniye, Turkey
Preferred Abstract (Original): 

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.

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