V10-08 ADJUSTABLE RETROPUBIC SLING FOR SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE IN COMPLICATED CASES

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You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2018V10-08 ADJUSTABLE RETROPUBIC SLING FOR SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE IN COMPLICATED CASES Dmitry Shkarupa, Nikita Kubin, Olga Staroseltseva, Ekaterina Shapovalova, and Anastasia Zaytseva Dmitry ShkarupaDmitry Shkarupa More articles by this author , Nikita KubinNikita Kubin More articles by this author , Olga StaroseltsevaOlga Staroseltseva More articles by this author , Ekaterina ShapovalovaEkaterina Shapovalova More articles by this author , and Anastasia ZaytsevaAnastasia Zaytseva More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Midurethral sling is a standard primary surgical procedure for female stress urinary incontinence (SUI). Retropubic (RP) sling shows higher effectiveness than transobturator (TO) in patients with recurrent SUI. At the time, bladder outlet obstruction (BOO) is a common complication of RP sling. The purpose of the study was to evaluate the effectiveness and safety of retropubic adjustable sling in patients with complicated SUI. METHODS Our study comprised 43 women suffering from SUI and who had one or more predictors of surgical failure such as previous anti-incontinence surgery or pelvic organ prolapse repair, intrinsic sphincter deficiency, severe SUI and concomitant morbidity. All patients underwent RP adjustable sling insertion. We used monofilament polypropylene sling with special threads, which allow to tune its tension during 2 days after surgery. The pre- and postoperative evaluation included urogynecological history, vaginal examination, cough stress test (CST), urodynamic study, bladder ultrasound and post-void residual urine volume (PVR) measurement, 1-hour Pad-test, questionnaires (UDI-6, UIQ-6, PFIQ-7, ICIQ-SF). RESULTS Mean surgery time was 27,5±10,1 min. There were no cases of intraoperative bladder injury or clinically significant bleeding. The next day after surgery 25 patients (51,8%) required tension adjustment. The tension was increased in 14 (32,5%) patients presented with positive CST and decreased in 11 (25,6%) patients, who had obstructive flow pattern, complaints of a slow or intermittent stream and PVR>100 ml. This procedure was repeated in 7 (16,3%) because of positive CST at the following examination. After adjustment, all patients were continent, with PVR≤ 60 ml. There were no cases of BOO or urinary retention after tension adjustment. None of the patients required intermittent or indwelling catheterization. Mean follow-up was 8.8±4.4 months.The objective cure rate was 95,4% (n=41). There was no significant decrease of Qmax (p>0,05). We had 3 (6,9%) cases of vaginal mesh extrusion in patients who had a history of vaginal mesh surgery. None of them underwent tension adjustment. There were no cases of wound infections, chronic pain or dyspareunia and no cases of BOO during follow-up. The questionnaires scores showed 88,3% (n=38) patients to be very satisfied with great improvement of the quality of life (p<0,001). CONCLUSIONS The adjustable retropubic sling is a good option for treating patients with risk factors of failure. It provides high objective and subjective cure rate and low complication number. At the same time, it allows to minimize the risk of postoperative voiding dysfunction © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1075 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dmitry Shkarupa More articles by this author Nikita Kubin More articles by this author Olga Staroseltseva More articles by this author Ekaterina Shapovalova More articles by this author Anastasia Zaytseva More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...