The Combined Intravaginal Sling and Tuck Operation. An Ambulatory Procedure for Cure of Stress and Urge Incontinence

Abstract

Thirty patients with symptoms and signs of stress and urge incontinence were treated with a Combined Intravaginal Sling and Tuck procedure. Primarily, only the first part of the procedure, the Sling operation was undertaken. This procedure creates an artificial pubourethral ligament which is achieved by controlled deposition of collagen around a retropubically implanted, removable, 0.5 cm wide Mersilene tape, inserted through a special tunneler. This part, stage 1 of the combined surgical procedure is mainly performed under local anaesthesia without postoperative catheterization, and early return to work. Urgency symptoms were cured simultaneously with the stress symptoms. The 50% success rate of the sling procedure was improved to 82% when the second part (stage 2) of this operation was undertaken. This procedure, the “Tuck” operation, tightens the suburethral vagina. The results of the combined procedure indicate that both an intact pubourethral ligament and tight suburethral vagina are equally important for cure as proposed in the Integral Theory of Female Urinary Incontinence.