Sling For Stress Urinary Incontinence Research Articles

Can midurethral slings for stress urinary incontinence treat concomitant detrusor overactivity and urge incontinence?

Can midurethral slings for stress urinary incontinence treat concomitant detrusor overactivity and urge incontinence?

The Long-Term Results of Pubovaginal Sling Surgery Using Acellular Cross-Linked Porcine Dermis in the Treatment of Urodynamic Stress Incontinence

Acellular cross-linked porcine dermis is a potential substitute for rectus fascia as a sling material with the advantage of decreased morbidity. However, the long-term efficacy is unknown. We compared the 3-year efficacy of PD vs autologous rectus fascia as a sling material for pubovaginal sling surgery in the treatment of urodynamic stress incontinence. Between July 2000 and December 2001 a total of 101 consecutive, nonrandomized patients with USI underwent a PD (51) or RF (50) sling procedure. Patients were assessed at 6 weeks, and at 3, 6 and 12 months postoperatively. Urodynamic study was repeated in cases of treatment failure. A detailed survey questionnaire was mailed to all patients at least 36 months after surgery and all responders were then retested by telephone interview by a blinded assessor. The primary outcome measure was patient perceived success rate (cured or improved) at least 36 months after PVS. Secondary outcome measures were patient satisfaction 36 months after surgery, durability of success with time and reoperation rate. Complete data were available on 94 patients (48 treated with PD and 46 treated with RF sling). The groups were well matched for age, leak point pressure, prior incontinence surgery and urge symptoms. Pubovaginal sling was successful (cured or improved) in 37 (80.4%) patients treated with RF but in only 26 (54%) patients treated with PD 36 months after surgery (Fisher's exact test p = 0.009; 95% CI 8.03, 44.4). Treatment failure occurred by 9 months after RF and by 24 months after PD sling procedure. Repeat urodynamic study showed USI to be the cause of treatment failure in 18 (37.5%) of 20 patients treated with PD but in only 3 (6.5%) of 8 patients treated with RF. We have shown that use of the PD sling, although reducing early morbidity, results in a significantly inferior long-term cure rate in comparison to the RF sling. Therefore, acellular cross-linked porcine dermis should not be used as a substitute for rectus fascia.

Bladder neck broad based polypropylene sling for stress urinary incontinence

<b>Objectives</b> : Bladder neck suspension using polypropylene is an established technique for treatment of stress urinary incontinence (SUI). We report our retrospective audit of the bladder neck sling in SUI. <b> MaterialS and Methods</b> : Twenty-one patients with SUI operated at our institute were included in the study. The audit was performed using the case records for - patient demographics, detailed history and examination, routine hemogram, renal function tests, urine culture sensitivity, urine microscopic examination and uroflowmetery + cystometrogram(CMG). After complete evaluation, all patients underwent bladder neck suspension using polypropylene mesh. <b> Results</b> : Twenty-one patients with mean age of 55 years underwent bladder neck sling surgery. Mean duration of surgery was 67 minutes (50-100 minutes). Mean operative blood loss of 100ml. Mean duration of hospital stay was 2days (1-5 days). Eighteen patients had complete or significant decrease in the severity of stress urinary incontinence in immediate post-operative period. Mean duration of follow up of patients was 19 months (3-28 months). All patients were dry at the end of the follow up. <b> Conclusions</b> : Broad base polypropylene mesh gives good continence results in patients of SUI.

Complications From Transvaginal Pubovaginal Slings Using Bone Anchor Fixation

Objectives: To evaluate the history and management of complications from transvaginally placed pubovaginal slings using bone anchor fixation. Methods: During a 3-year period, 10 patients were referred to us for complications related to transvaginally placed pubovaginal slings using bone anchor fixation. Results: The patient age ranged from 42 to 73 years. All women had a vaginally introduced bone anchor sling for stress urinary incontinence. The presenting symptoms after surgery included fever, pain, and difficulty ambulating in 1; pain and/or vaginal dyspareunia with discharge in 5: pain or dyspareunia alone in 2; and vaginal discharge alone in 2 patients. Two patients ultimately developed bone lesions on radiologic studies consistent with osteomyelitis. Six patients developed sinus drainage tracts associated with granulation tissue from at least one bone anchor that was unresponsive to outpatient management. One of the patients with pain alone had a permanent suture extending into the bladder neck. Nine patients underwent surgery, of whom five had resolution of their presenting complaint. Four of these patients were continent at last follow-up. Conclusions: Transvaginally placed pubovaginal slings using bone anchors can be associated with serious complications that may be intractable to common therapies. This knowledge may enable practitioners who use this technique to better counsel their patients regarding these significant complications.

Which sling for stress urinary incontinence?

In recent years, the possibilities for treating stress urinary incontinence have increased dramatically. Since the introduction of TVT in 1996 and due to its success, many new suburethral slings were developed. In this article, the way of deciding which surgical treatment is most appropriate is described. Decision making about surgical treatment of stress urinary incontinence is based on a sound pre-operative diagnosis and should be preceded by looking at non-surgical interventions. The choice between the several surgical options should first be to consider its effectiveness (high clinical success rate and positive change in quality of life). Second, the surgical procedure should be the least invasive one. Third, it may not have major anatomical and functional adverse effects. And finally, the procedure should have a beneficial cost-effectiveness ratio.

Poster 52: Transobturator (TOT) Suburethral Sling: Early U.S. Data on Safety and Efficacy

OBJECTIVE: This study was a report on early U.S. experience, including safety and efficacy of the new transobturator (TOT) sling for stress urinary incontinence. METHODS: This a retrospective case series of the initial 210 consecutive cases of TOT slings from 2 U.S. centers performed from August 2002 to December 2004. Cure was defined as subjective resolution of stress incontinence. QOL data was obtained using the short forms of the IIQ and UDI. RESULTS: Follow-up data were available on 209 patients. The mean (standard deviation) for subjective and objective follow up was 8.7 (4.5) months and 4.1 (3.4) months, respectively. The mean values (range) for age, parity, and body mass index were 58.5 years (30–83), 2.4 (0–8), and 27.96 (15.6–48.7), respectively. Twenty percent (n=42) of patients had prior incontinence surgery. Preoperatively, 45.9% (n=96) had mixed incontinence and 8.6% (n=18) had voiding dysfunction. Forty-two (20%) patients underwent an isolated sling procedure and the remaining had additional procedures. One hundred eighty-four patients (88%, 95% confidence interval: 83–92%) reported cure of SUI, 4 (1.9%) patients were improved, and 22 (10.5%) failed. The statistically significant difference between the cured and failed groups was: 1) failed patients needed longer postoperative catheterization (3.6 days ± 6.5 vs 1.5 ± 2.2, P=0.02) and 2) patients who had other additional procedures were more likely to report a cure (91% vs 76%, P=0.01). Mean duration of postoperative catheterization was 1.2 days. There were 2 (0.9%) intraoperative complications, one cystotomy, and one urethral injury. Nineteen patients (9.1%) had post op complications: 2 hematomas, one erosion, and 16 with groin pain. Five (2.8%) patients developed obstructive voiding dysfunction. Of these, 4 patients underwent sling release and one patient needed intermittent self-catheterization for 4 weeks. Twenty-three (11%) patients developed de novo urge incontinence. Reoperation rate was 6.6% (n=14): 3 sling plications and 5 TVTs for recurrent SUI, 4 sling releases, and 2 vaginoplasties. Postoperative QOL data was available for 137 (65.5%) patients and the mean IIQ-7 score was 1.04 (standard deviation [SD] 2.78) and the mean UDI-6 score was 2.21(SD 2.80). CONCLUSION: Early data suggests that the TOT sling is safe and effective. Longer-term studies are needed.

Complications from transvaginal pubovaginal slings using bone anchor fixation

Objectives To evaluate the history and management of complications from transvaginally placed pubovaginal slings using bone anchor fixation. Methods During a 3-year period, 10 patients were referred to us for complications related to transvaginally placed pubovaginal slings using bone anchor fixation. Results The patient age ranged from 42 to 73 years. All women had a vaginally introduced bone anchor sling for stress urinary incontinence. The presenting symptoms after surgery included fever, pain, and difficulty ambulating in 1; pain and/or vaginal dyspareunia with discharge in 5; pain or dyspareunia alone in 2; and vaginal discharge alone in 2 patients. Two patients ultimately developed bone lesions on radiologic studies consistent with osteomyelitis. Six patients developed sinus drainage tracts associated with granulation tissue from at least one bone anchor that was unresponsive to outpatient management. One of the patients with pain alone had a permanent suture extending into the bladder neck. Nine patients underwent surgery, of whom five had resolution of their presenting complaint. Four of these patients were continent at last follow-up. Conclusions Transvaginally placed pubovaginal slings using bone anchors can be associated with serious complications that may be intractable to common therapies. This knowledge may enable practitioners who use this technique to better counsel their patients regarding these significant complications.

Intravaginal sling in stress urinary incontinence

Intravaginal sling in stress urinary incontinence

Initial Experience With Acellular Human Dermal Allograft (Repliform) Pubovaginal Sling for Stress Urinary Incontinence

Initial Experience With Acellular Human Dermal Allograft (Repliform) Pubovaginal Sling for Stress Urinary Incontinence

Prospective Analysis Of Patients Treated With A Distal Urethral Polypropylene Sling For Symptoms Of Stress Urinary Incontinence: Surgical Outcome And Satisfaction Determined By Patient Driven Questionnaires

We evaluated the safety and efficacy of the distal urethral polypropylene sling for stress urinary incontinence using patient self-assessment by questionnaires. We performed a prospective study of all consecutive patients who underwent a mid distal urethral sling procedure between November 1999 and February 2002. Surgical outcome was determined by symptom, bother and quality of life questionnaires completed by the patients. The physicians were blinded to patient responses. These outcomes were compared to the SEAPI determined by the physician and to physical examination findings. There were 301 patients, of whom 2.3% required treatment for persistent stress urinary incontinence (SUI) after the polypropylene sling procedure. In the 92 patients with a minimum followup of 12 months the objective cure rate was 92%. The patient determined subjective success rate (cure and improved greater than 50%) was 89%. On questionnaires only 69% of the patients reported no symptoms of SUI under any circumstance and the same number reported never being bothered by SUI. The physician determined SEAPI overestimated patient self-reported symptoms by 10% to 50% depending on the symptom. The polypropylene sling represents an inexpensive, safe and simple alternative treatment for patients with stress urinary incontinence. The procedure provides high objective and physician determined cure rates but a lower patient self-reported subjective cure rate. Patient self-assessment of symptoms, bother and quality of life should be an integral part of the outcome of stress urinary incontinence surgery.

Broad Based Tension-Free Synthetic Sling for Stress Urinary Incontinence: 5-Year Outcome

The use of nonabsorbable synthetic material has been questioned due to reports of erosion and infection. We present the 5-year followup outcome of stress urinary incontinence (SUI) treated using polypropylene mesh as a pubovaginal sling. A retrospective analysis was performed of 58 consecutive patients who underwent pubovaginal sling procedures using polypropylene mesh since April 1996 for types II and III SUI at our institution. The technique included a single midline anterior vaginal wall incision with full-thickness flaps. Broad based polypropylene mesh was used to support the vesicourethral junction entering the retropubic space through the endopelvic fascia and bone anchors were used for fixation. Patient satisfaction was evaluated during followup office visits and/or telephone interview by an individual not involved in any surgeries. All procedure failures were evaluated by urodynamics. Of the 58 patients 49 were available for analysis. Average followup was 59.34 months (range 29 to 77). Of the 49 patients 40 (81.63%) were dry and 2 (4.08%) improved (1 pad daily). De novo urgency and urgency related incontinence was reported in 1 case each. Three patients (8.16%) had recurrent SUI, while prolonged retention developed with subsequent urethrolysis required in 2 (4.08%). None of the patients have experienced infection, nonhealing or erosion of the synthetic slings to date. In our experience polypropylene mesh used as a broad based tension-free sling was successful for treating all types of SUI. In our opinion technique and case selection have a bearing on outcomes.

Risk Factors for Rejection of Synthetic Suburethral Slings for Stress Urinary Incontinence

Risk Factors for Rejection of Synthetic Suburethral Slings for Stress Urinary Incontinence

Risk factors for rejection of synthetic suburethral slings for stress urinary incontinence: a case-control study

OBJECTIVE: To identify variables associated with rejection of synthetic, suburethral slings used for female stress urinary incontinence. METHODS: Between 1991 and 1998, gynecologists at our department performed 428 operations for stress urinary incontinence by inserting expanded polytetrafluoroethylene or polyethylene suburethral slings. After suitable exclusions, 386 women followed for at least 24 months after surgery remained for analysis. Of the 386 women, 47 (12.2%) had graft rejection or symptoms associated with rejection within 24 months after surgery, which led to later removal. We compared cases and controls using logistic regression analyses with forward selection to identify independent risk factors and risk markers for rejection. RESULTS: The rejection rate declined sharply during the years 1993–1994 after introduction of routines that included preoperative prophylactic antibiotics active against anaerobes and repeated preoperative treatment of the vagina with chlorhexidine acetate. After adjusting for potentially confounding variables, surgery after 1993, the gynecologist performing the procedure, and adequate antibiotic prophylaxis remained significantly associated with a lower rejection rate. There was no significant association between rejection and sling material, age at surgery, year of surgery (in one year steps), or concomitant prolapse surgery. CONCLUSION: Rejection of suburethral slings might be associated with bacterial contamination of the graft, and the rate was decreased with prophylactic antibiotics a repeated and vaginal disinfection.

The male sling for stress urinary incontinence: a prospective study.

This is a report of a prospective study of the male sling for treating stress urinary incontinence. A total of 21 men underwent sling surgery. There were 2 titanium screws loaded with polypropylene suture placed in each descending pubic ramus through a 3.5 cm. perineal incision at the level of the bulbar urethra. A polypropylene mesh was placed over the urethra and tied to the bone anchors, adjusting sling tension to a compression pressure of 60 cm. water. Followup was done with the incontinence section of the University of California, Los Angeles/RAND Prostate Cancer Index. Mean followup was 12 months (range 5 to 21). Overall, incontinence was cured in 16 (76%) patients, substantially improved (stress urinary incontinence very small or small problem, 1 pad daily) in 3 (14%), somewhat improved (moderate problem-2 pads) in 1 and procedure failed (no improvement) in 1 (5%). The patients with stress urinary incontinence after undergoing transurethral prostatectomy were cured, as was the individual with myelomeningocele. Of the 18 patients with stress urinary incontinence after radical prostatectomy 13 were cured, including 1 of 2 who underwent previous artificial urinary sphincter placement and 2 of 3 adjuvant radiation. There was significant improvement in each survey question, and the total score improved from a mean plus or minus standard deviation of 65 +/- 11 preoperatively to 397 +/- 29 postoperatively (p <0.001). There was no retention, infection, erosion or de novo voiding dysfunction. This minimally invasive sling surgery has not been associated with any significant complication, and early results compare favorably with artificial urinary sphincter. By compressing only the ventral urethra the risk of urethral erosion and atrophy is reduced. Prior radiation or artificial urinary sphincter does not appear to be a contraindication to sling surgery.

Pubovaginal sling for stress urinary incontinence: analysis of results and quality of life assessment

Pubovaginal sling for stress urinary incontinence: analysis of results and quality of life assessment

THE IN SITU ANTERIOR VAGINAL WALL SLING: PREDICTORS OF SUCCESS

We assessed the outcome of the in situ anterior vaginal wall sling for stress urinary incontinence, identified any predictors of success and reviewed the current literature on this topic. We identified all patients who underwent an isolated anterior vaginal wall sling procedure in a 16-month period. Charts were reviewed and telephone interviews were performed to assess the success rate of the procedure and identify parameters that may influence outcome. The pertinent literature was identified. Of the 42 patients identified 39 had evaluable data available. The overall success rate was 79.5% at an average 19-month followup. Abdominal Valsalva leak point pressure 50 cm. water or greater was identified as a significant predictor of success (p = 0.002). The success rate was 93% and 40% in patients with a Valsalva leak point pressure of 50 or greater and less than 50 cm. water, respectively. The pertinent literature was reviewed. The anterior vaginal wall sling is effective for stress urinary incontinence. In patients with a Valsalva leak point pressure of 50 cm. water or greater the success rate is 93%. We recommend the anterior vaginal wall sling procedure in these patients but different treatment in those with Valsalva leak point pressure less than 50 cm. water.

REVISION RATE AFTER ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR INCONTINENCE AFTER RADICAL PROSTATECTOMY: ACTUARIAL ANALYSIS

We determined the actuarial revision rate for artificial urinary sphincters implanted in patients who were incontinent after radical prostatectomy. We reviewed the records of 70 consecutive patients who were incontinent after radical prostatectomy and who underwent primary artificial urinary sphincter implantation at the University of Michigan between 1984 and 1999. Questionnaires were mailed to all patients with an indwelling device, and telephone calls were placed to those who did not respond to the mailing. Information about surgical revision and current continence status was obtained from chart review and questionnaire response. The Kaplan-Meier curves for actuarial freedom from operative revision were constructed. Of the 66 patients with available postoperative data 24 (36%) required reoperation at a mean followup of 41 months. The 5-year actuarial rate for freedom from any operative revision was 50%, and the corresponding rate for cuff revision was 60%. A single operative revision did not predispose the patient to further revision. Questionnaire data indicated a continence rate of 80% (range 0 to 2 pads). Approximately half of the patients who were incontinent after radical prostatectomy may expect to undergo operative revision within 5 years after artificial urinary sphincter implantation. Despite this high reoperation rate, an excellent level of continence is maintained.

Clinical Outcome Between Fixations of the Rectus Fascia to the Cooper's Ligament and Abdominal Wall in Pubovaginal Sling Operation

Purpose:Pubovaginal fascial sling for stress urinary incontinence has never achieved widespread application because of a perception that the complication rate (prolonged urinary retention and secondary detrusor instability) is relatively high. We performed modified pubovaginal fascial sling operation and compared the safety and efficacy of the Cooper's ligament fixation with those of abdominal wall fixation of rectus fascia in pubovaginal sling. 6) Mat eri a l s a nd Met hod s:We retrospectively compared 30 women treated with pubovaginal fascial sling procedure as Blaivas described in 1995(Group I) with 30 women treated with a modified technique included fixation of sling to the Cooper's ligament(Group II). Patients were eval-

Pubovaginal sling for stress urinary incontinence: analysis of results and quality of life assessment

Pubovaginal sling for stress urinary incontinence: analysis of results and quality of life assessment

PROTRACTED URINARY RETENTION NECESSITATING URETHROLYSIS FOLLOWING TENSION-FREE VAGINAL TAPE SURGERY

The fascial pubovaginal sling for stress urinary incontinence is effective and durable. Various techniques and materials have been developed, including polypropylene tension-free vaginal tape. Contrary to other synthetic slings, tension-free vaginal tape reportedly has a low complication rate.1,2 We report on a case of long-term urinary retention after tension-free vaginal tape surgery, which required urethrolysis and partial sling excision.