The Use of Biomaterials in Incontinence Surgery

Abstract

Introduction: We describe a minimally-invasive surgical technique using a naturally-derived porcine dermal collagen (Pelvicol™ Implant) that can be used in the treatment of all types of urinary stress incontinence and does not rely on permanent sutures. Patients and Methods: Sling procedures using the Pelvicol™ Implant were carried out in 27 patients (age range 31–76 years; average 52 years) with genuine stress incontinence over a 12-month period. Patients had primary genuine stress urinary incontinence (SUI) ( n=14), and mixed SUI complicated by complaints of urgency or frequency and a previous history of surgery ( n=13). Detrusor instability was ruled out in all patients via cystometry, and patients were followed up for a minimum period of 6 months. Results: In patients with genuine SUI, 86% of patients remained dry. In patients with mixed SUI, a small number of retentions and de novo urgencies were observed and 62% of patients remained dry. The mean time to insert the sling was 20 minutes and mean operation time was 45 minutes. There were no serious bleeds or infections. Three bladder perforations occurred, but the slings were repositioned with no further problems. Conclusions: This new surgical procedure can be used either as a tension-free sling in Type II patients or as a classical sling in complicated Type III incontinence patients. It is easy to teach and perform, it is fast and cost-effective, and it provides a good alternative to TVT.