Korean J Urol.  2011 Mar;52(3):184-188.

How to Achieve Long-Term Success in the Treatment of Female Urinary Stress Incontinence? Novel Modification on Vaginal Sling

• Mustafa M

Abstract

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.

Keyword

Incontinence; In situ vaginal sling; Urinary incontinence, stress

MeSH Terms

Dislocations
Female
Follow-Up Studies
Humans
Mucous Membrane
Polypropylenes
Relaxation
Suburethral Slings
Sutures
Urinary Incontinence
Urinary Incontinence, Stress
Urinary Retention
Polypropylenes

Figure

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  FIG. 1 Schematic illustration of the placard-shaped incision made at the anterior vaginal wall before starting dissection.

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  FIG. 2 In situ sling prepared from the anterior vaginal wall.

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  FIG. 3 Polypropylene mesh of similar size to the in situ sling with two lateral suspension sutures.

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