Sling Procedure For Stress Incontinence Research Articles

Postoperative Admission, Readmission, and Complications for Patients 60 Years and Older Who Are Undergoing an Isolated Sling Procedure for Stress Incontinence: A Database Study.

The aim of the study was to determine the effect of increasing age on postoperative admission, readmission, and complications for patients 60 years and older who underwent a synthetic or autologous sling procedure for stress incontinence. A retrospective cohort study of surgical cases from 2012 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program database was conducted. Eligible patients were at least 60 years old and underwent an isolated sling procedure for stress incontinence identified by Current Procedural Terminology code 57288. Baseline demographics, preoperative comorbidities, and postoperative complications were obtained. Risk ratios (RRs) and 95% confidence intervals were calculated using log-binomial regressions. Of 3,960 eligible patients, 634 (16.0%) were admitted postoperatively. Admission rates differed across age groups (P = 0.04). For example, compared with patients aged 60-64 years, those aged 70-74 years had 1.3 times the risk of admission (95% confidence interval, 1.04-1.6). Other risk factors for admission included diabetes (RR, 1.3) and hypertension (RR, 1.2). Patients who had general anesthesia had 6.3 times the risk of admission compared with those who had monitored anesthesia/intravenous sedation. There were 72 patients (1.8%) readmitted within 30 days. There was no association between age and readmission. Risk factors for readmission included diabetes (RR, 1.8), bleeding disorders (RR, 3.4), severe chronic obstructive pulmonary disease (RR, 3.7), and congestive heart failure (RR, 11.3). There were 192 complications (4.8%), including 45 major complications (1.1%). Among patients 60 years and older, the risk of postoperative admission and readmission for patients undergoing a synthetic or autologous sling procedure is low and complications are uncommon.

Outcomes of the association of asymptomatic cystocele repair in patients undergoing mid-urethral sling surgery for the correction of stress incontinence

BackgroundComparison between the clinical outcomes of mid-urethral sling procedure for stress incontinence with and without repair of asymptomatic stage II cystocele is made.MethodsThis is a prospective randomized study of 72 female patients with stress urinary incontinence and asymptomatic stage II cystocele. The patients were divided into two groups: group 1 treated with trans-obturator tape only and group 2 with repair of cystocele by anterior colporrhaphy in the same session. We compared between both groups in cure rate and voiding function after 1 year.ResultsThe cure rate of group 1 was 66.7%, while for group 2 it was 90% after 12 months (p < 0.05). Six patients (17%) with asymptomatic stage II cystocele in group 1 became symptomatic or developed higher stage after 12 months that required surgical repair. The incidence of postoperative irritative urinary symptoms was also significantly higher in group 1. There were no significant differences in the change in maximum flow rate or postvoiding residual urine between the two groups postoperatively.ConclusionConcomitant repair of stage II asymptomatic cystocele with mid-urethral sling improves the cure rate of stress urinary insentience and reduces the incidence of irritative urinary symptoms.

Resident simulation training improves operative time of the retropubic midurethral sling procedure for stress incontinence.

Our aim was to assess whether immediate preoperative resident simulation training decreases operative time and improves resident proficiency when performing a retropubic midurethral sling (MUS) procedure. This prospective cohort study took place over 8months at the Icahn School of Medicine, New York, USA. During the first 4months, all retropubic MUS procedures were performed by residents who underwent immediate preoperative simulation training. The cases completed during the following 4months were performed by residents who had not received preoperative simulation training. During the 8-month period, residents completed self-assessment questionnaires upon completion of the surgery and attendings evaluated the residents using the Objective Structured Assessment of Technical Skills (OSATS) global rating scale. Operative time between the two periods were compared using two-sample Student's t test. Comparative analysis between groups was performed based on the OSATS scores using the Wilcoxon rank-sum nonparametric test. There were 22 cases in the simulation group (SG) and 20 in the no simulation group (NSG). SG mean operative time was 12.6min and NSG mean operative time was 14.6min (p = 0.12). The SG mean OSATS score was 30.4 versus NSG of 27.8 (p < 0.001). This study demonstrates that preoperative simulation significantly improves operative performance of the retropubic MUS procedure among residents and also improves their confidence in the operating room. There was a decrease in mean operative time of 2min in the SG, but the difference was not statistically significant. This data is consistent in demonstrating improved surgical performance and resident confidence with simulation training.

Prevalence of urinary urgency symptoms decreases by mid-urethral sling procedures for treatment of stress incontinence

Conflicting opinions on the effect of incontinence surgery on the prevalence of postoperative urgency symptoms exists. Our aim was to evaluate the prevalence of urgency symptoms preoperatively and during 3-year of follow-up in women undergoing mid-urethral sling procedures for stress incontinence. Two hundred and sixty-seven women were randomly assigned to a retropubic or a transobturator operation. Detrusor instability score (DIS) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to assess prevalence of urgency symptoms. The Incontinence Impact Questionnaire-7, visual analog scale, urinary incontinence severity score, and the EuroQol-5D assessed overall quality of life changes. A significant decrease in the DIS and UDI-6 score was seen postoperatively. Signs of de novo urgency symptoms were low. Mid-urethral sling procedures can be recommended in cases of mixed incontinence, and the procedures seems to decrease prevalence of urgency symptoms.

Laparoscopic management of genital prolapse

Genital prolapse is one of the most common indications for gynaecological surgery. Surgery is performed traditionally via abdominal, vaginal and laparoscopic approaches. A MEDLINE computer search was performed to explore the recent evidence behind laparoscopic surgery for female pelvic organ prolapse. Advances in minimal access surgery have led to an increase in adoption of laparoscopic techniques. Current evidence supports the use of laparoscopy for sacrocolpopexy and colposuspension as an alternative to open surgery. However, the introduction of less invasive midurethral sling procedures for stress incontinence has reserved laparoscopic colposuspension for special indications. The scientific evidence regarding uterosacral suspension procedures and paravaginal and vaginal prolapse repairs are sparse. The current evidence supports the outcome of laparoscopic sacrocolpopexy as an alternative to open surgery. Further studies are required on the long-term efficiency in laparoscopic paravaginal repair and vaginal wall prolapse.

Sling procedures after repair of obstetric vesicovaginal fistula in Niamey, Niger

The purpose of this paper is to evaluate the results of sling procedures for stress incontinence after repair of vesicovaginal fistulae at the National Hospital in Niamey, Niger. This study is a retrospective chart review of 701 women surgically treated for vesicovaginal fistulae. One hundred forty women subsequently underwent a sling procedure for stress incontinence after fistula repair. The demographics among the groups were similar. No significant difference was seen in results between the sling types except the risk of erosion was significantly greater in the synthetic sling group. There was a trend towards greater sling success in the fascia lata group. Correction of incontinence is a common and difficult challenge following repair of obstetric vesicovaginal fistula. Compared to published studies on sling procedures, these patients have higher rates of continued incontinence. This is likely due to the frequent loss of a urethral sphincter as well as high prevalence of detrusor overactivity and decreased bladder capacity.

Long-Term Results of Bulking Agent Injection for Persistent Incontinence in Cases of Neurogenic Bladder Dysfunction

We evaluated the effectiveness of bladder neck injection as a supplementary treatment for persistent low pressure incontinence after unsatisfactory fascial sling procedures in patients with neurogenic lower urinary tract dysfunction. A total of 89 patients with neurogenic lower urinary tract dysfunction underwent fascial sling procedures between 1992 and 2005. Because of unsatisfactory results, 27 patients received endoscopic injection of a bulking agent. All patients included in the study underwent urodynamic examination after the sling procedure, which revealed persistent low pressure transurethral leakage of urine. We retrospectively analyzed the endoscopic approach used to administer the bladder neck injection, method of postoperative catheterization and number of injections given. Efficacy of bladder neck injection was graded by the patient and the urologist. After a median followup of 8 years (range 2.5 to 14) only 2 patients (7%) were continent after having received a single injection of bulking agent. A total of 12 patients (44%) were given a second injection and 8 (30%) were given a third injection but these subsequent injections did not result in continence. Of the patients 16 (59%) eventually underwent bladder neck surgery, 2 (7%) were dry and 8 (30%) accepted the inconvenience. Two patients underwent ileocystoplasty and 1 patient underwent botulinum A toxin (Botox(R)) injection due to decreased bladder capacity and poor bladder compliance. Neither the endoscopic approach nor the method of postoperative catheterization affected the success rate. Bladder neck injection after failure of primary sling procedures has limited value in patients with neurogenic lower urinary tract dysfunction. Repeat bladder neck injection yields no additional benefits.

Cadaveric fascia lata sling for stress urinary incontinence: A prospective quality-of-life analysis

Objective The purpose of this study was to describe the effects of full-length cadaveric fascia lata (CFL) sling on quality-of-life outcomes. Study design Patients were 102 women (aged 29 to 87 years) who underwent the sling procedure for stress incontinence associated with intrinsic sphincter deficiency. They were followed up at 12, 24, 36, and 48 months with the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and a patient satisfaction questionnaire. Results Mean IIQ score declined from 55.1 before surgery to 11.0 at 12 months ( P<.001). Mean UDI score declined from 67.1 to 28.0 at 12 months ( P<.01). At 12 months, 79.7% of patients reported that leakage was better or much better, and 90.2% reported that they were somewhat or completely satisfied with their progress. Results were maintained throughout the 48-month follow-up period. Conclusion The CFL sling procedure has an enduring beneficial effect on lower urinary tract symptoms and quality of life.

Accidental burns caused by domestic infra-red muscle massaging device

A 40-year old female patient underwent a routine rectus sling procedure for stress incontinence. During the second night post operatively, nursing staff discovered three circular, full thickness burns on the lower part of her abdomen (Fig. 1). At the time of this observation the patient was asleep. She was in the habit of using a hand held infra-red muscle massager (Fig. 2) for chronic back pain and had

Pubovaginal sling procedure for stress incontinence

Urinary stress incontinence associated with poor urethral sphincter function and indicated by a urethral pressure of less than 10 cm. water was treated in 52 cases with a pubovaginal autogenous fascial sling. No urethral sphincter function could be measured in 7 patients. Of these 52 patients 42 had undergone a previous operation for stress incontinence. The uninhibited detrusor dysfunction that accompanied the stress incontinence in 29 cases ceased after operation in 20 but persisted in 9. Postoperative urethral pressure measurements indicated that while the sling increased urethral pressure it did not cause an obstruction during voiding, since there was a measurable decrease in urethral pressure during a detrusor contraction. Urodynamic determinations were useful in patient selection, in the adjustment of sling tension at operation and in the assessment of reasons for failure. A satisfactory result with good urinary control was obtained in 50 cases and the procedure was a failure in 2.

COMPLICATIONS AND INITIAL CONTINENCE RATES AFTER A REPEAT PUBOVAGINAL SLING PROCEDURE FOR RECURRENT STRESS URINARY INCONTINENCE

No AccessJournal of UrologyCLINICAL UROLOGY: Female Urology1 Jun 2001COMPLICATIONS AND INITIAL CONTINENCE RATES AFTER A REPEAT PUBOVAGINAL SLING PROCEDURE FOR RECURRENT STRESS URINARY INCONTINENCE STEVEN P. PETROU and IGOR FRANK STEVEN P. PETROUSTEVEN P. PETROU Financial and/or other relationship with Bard, American Medical Systems, Upjohn Pharmacia and Timm Medical. More articles by this author and IGOR FRANKIGOR FRANK More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66257-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the safety and efficacy of repeat pubovaginal sling procedures for recurrent stress urinary incontinence. Materials and Methods: We retrospectively reviewed the records of 14 patients in whom an initial suburethral sling procedure failed, who then underwent a repeat pubovaginal sling procedure for recurrent stress urinary incontinence at our institution and who were available for followup evaluation. Mean followup after re-operation was 17 months (range 5 to 41). The response to surgery was assessed using the Blaivas-Groutz anti-incontinence surgery response score. Results: There were no intraoperative complications. Mean blood loss was 155 cc (range 50 to 750) and average operative time was 101 minutes (range 80 to 145). Long-term urinary retention developed in 1 of the 14 patients (7%). There were no deaths. Two patients (14%) had postoperative complications, including a pelvic abscess and osteomyelitis pubis in 1 each. Based on the Blaivas-Groutz anti-incontinence scale 7 of the 14 patients (50%) were cured, 1 (7%) had a good response, 4 (29%) had a fair response, 2 (14%) had a poor response and none had treatment failure. Subjectively 12 of the 14 women (86%) considered themselves cured or improved and 2 (14%) considered the operation to have failed. Conclusions: Our data imply that a repeat pubovaginal sling procedure after an initial failed operation is associated with low complication and acceptable continence rates. It should be considered a reasonable treatment option in select women with recurrent stress urinary incontinence. References 1 : Pubovaginal sling procedure for stress incontinence. J Urol1978; 119: 82. Link, Google Scholar 2 : Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol1998; 160: 1312. Link, Google Scholar 3 : Favorable outcome of pubovaginal slings for geriatric women with stress incontinence. J Urol1997; 157: 125. Link, Google Scholar 4 : Expanded indications for the pubovaginal sling: treatment of type 2 or 3 stress incontinence. J Urol1996; 156: 1620. Link, Google Scholar 5 : An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome. J Urol1999; 162: 135. Link, Google Scholar 6 : Our experience with pubovaginal slings in patients with stress urinary incontinence. J Urol1998; 159: 1195. Link, Google Scholar 7 : A simplified urinary incontinence score for the evaluation of treatment outcomes. Neurourol Urodyn2000; 19: 127. Google Scholar 8 : Results of pubovaginal sling for the treatment of intrinsic sphincter deficiency determined by questionnaire analysis. J Urol1997; 158: 1738. Link, Google Scholar 9 : The effect of study methodology on reported success rates of the modified Pereyra bladder neck suspension. J Urol1995; 154: 1732. Link, Google Scholar 10 : A follow up of silastic sling for genuine stress incontinence. Br J Obstet Gynaecol1995; 102: 143. Google Scholar 11 : Vaginal wall sling for anatomical incontinence and intrinsic sphincter dysfunction: efficacy and outcome analysis. J Urol1996; 156: 166. Link, Google Scholar From the Department of Urology, Mayo Clinic, Jacksonville, Florida© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byRutman M, Deng D, Shah S, Raz S and Rodríguez L (2018) Spiral Sling Salvage Anti-Incontinence Surgery in Female Patients With a Nonfunctional Urethra: Technique and Initial ResultsJournal of Urology, VOL. 175, NO. 5, (1794-1799), Online publication date: 1-May-2006.CHOE J (2018) Suprapubic Sling Adjustment: Minimally Invasive Method of Curing Recurrent Stress Incontinence After Sling SurgeryJournal of Urology, VOL. 168, NO. 5, (2059-2062), Online publication date: 1-Nov-2002. Volume 165Issue 6 Part 1June 2001Page: 1979-1981 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsurinary incontinence, stressurethrareoperationMetricsAuthor Information STEVEN P. PETROU Financial and/or other relationship with Bard, American Medical Systems, Upjohn Pharmacia and Timm Medical. More articles by this author IGOR FRANK More articles by this author Expand All Advertisement PDF downloadLoading ...

AN ASSESSMENT OF THE SURGICAL OUTCOME AND URODYNAMIC EFFECTS OF THE PUBOVAGINAL SLING FOR STRESS INCONTINENCE AND THE ASSOCIATED URGE SYNDROME

Purpose We assessed the urodynamic changes after pubovaginal sling procedure for stress incontinence, particularly in regard to the associated symptoms of urgency, frequency, nocturia and urge incontinence, known as the urge syndrome. Materials and Methods A total of 85 women with proved stress incontinence underwent a pubovaginal sling procedure using rectus fascia between 1992 and August 1996. Of the women 41 (48%) had undergone previous anti-incontinence surgery and 59 (69%) had the associated urge syndrome. There was at least some degree of hypermobility in 51 cases and type III stress incontinence was diagnosed in 34. Patients were assessed with a questionnaire and video urodynamics preoperatively and 3 months postoperatively. Preoperative and postoperative ambulatory studies were performed in 25 cases. Results Of the 85 patients 83 (97%) were symptomatically cured of stress incontinence. The urge syndrome resolved in 32 patients (69%), almost all of whom had a closed bladder neck at rest. Overall bladder neck incompetence at rest decreased from 57 to 18% (p <0.001). Of 27 patients with the persistent urge syndrome postoperatively 9 (41%) had an open bladder neck at rest compared to 4 of 50 (8%) without urge incontinence (p <0.01). Despite symptomatic control of stress incontinence in 83 patients (97%), only 66 were satisfied with the surgical result, mainly because of the persistent urge syndrome in 27. Despite care to avoid obstruction overall, there were statistically significant obstructive changes in detrusor pressure at maximum flow rate, maximum flow rate and residual urine volumes. Conclusions The pubovaginal sling is effective in curing genuine stress incontinence and, when correctly placed at the right tension, the associated urge syndrome also can be managed, usually by achieving bladder neck closure at rest. However, despite careful maneuvers, obstruction occasionally persists.

Pubovaginal sling procedure for stress incontinence

Pubovaginal sling procedure for stress incontinence

Experimental Evaluation of Free Versus Pedicled Fascial Flaps for Sling Surgery of Urinary Stress Incontinence

Bladder neck suspension using an autologous fascial sling is an established surgical technique for treatment of urinary stress incontinence. However, the biological fate and physical properties of autologous fascial sling yet remain to be determined. Our study was designed to evaluate in an animal model of twenty rabbits fascial slings from free and pedicled fascial flaps of two different widths (7 mm and 15 mm.) and uniform length (60 mm.) in respect to changes of length, width, tensile strength and histological criteria of vitality and integrity 3 months after surgery. The results 3 months after surgery revealed shrinkage in length by 37% (31%-46%) of the original length, shrinkage in width by 63% (60%-69%) of the original width and reduction of tensile strength of 53% (51%-55%) without consistent differences between free and pedicled flaps or 7 mm. and 15 mm. wide flaps. In the groups with 7 mm. wide flaps a total of two dystrophic slings (1 pedicled, 1 free) were seen; however, no dystrophies were seen in 15 mm. wide flaps. On microscopy, all slings were vital regardless of their surgical configuration. In summary, on macroscopic, microscopic and physical examination no gross differences between free and pedicled slings could be detected, so that preferences for use of free or pedicled fascial flaps could not be established for clinical applications in sling surgery. However, 15 mm. wide flaps had a lower incidence of dystrophy and retained greater absolute tensile strength than 7 mm. wide flaps.

Comparative Cost Analysis of Collagen Injection and Fascia Lata Sling Cystourethropexy for the Treatment of Type III Incontinence in Women

We examined the cost of 2 common forms of surgical treatment of genuine stress urinary incontinence due to intrinsic sphincter deficiency, that is sling cystourethropexy and periurethral collagen injection. Between May 1994 and July 1995, 14 women with intrinsic sphincter deficiency underwent sling cystourethropexies. A total of 14 matched patients with intrinsic sphincter deficiency underwent endoscopic collagen injection during the same period. The total cost per treatment of fascia lata sling cystourethropexy ($10,382) was 2.1 times greater than that for collagen injection ($4,996, p < 0.001). At an average followup of 14.9 months for fascia lata cystourethropexy and 21.3 months for collagen injection, 71.4% of patients in the former and 26.7% in the latter groups were completely continent (p = 0.05). One or no pads were used daily by 85 and 40% of the patients, respectively. Fascia lata sling cystourethropexy may be a more cost-effective surgical treatment than periurethral endoscopic collagen injection for treating genuine stress urinary incontinence in women with intrinsic sphincter deficiency when the greater success rate of the former procedure is considered.

Favorable Outcome of Pubovaginal Slings for Geriatric Women With Stress Incontinence

Traditionally pubovaginal slings have been associated with a greater risk of immediate morbidity and prolonged voiding dysfunction compared to other stress incontinence repairs. Because elderly patients already have inherently greater perioperative risk and prevalence of innate voiding dysfunction, there is some reluctance to construct slings in this age group. We examined the outcome of pubovaginal sling in elderly women versus younger controls to determine whether this concern is justified. We retrospectively analyzed the outcome of 19 geriatric women older than 70 years who underwent a pubovaginal sling procedure between 1992 and 1995, and compared the findings to those of 77 younger control women with a mean followup of 22 months. All women had video urodynamically proved stress incontinence due to intrinsic sphincter deficiency and many had coexistent bladder instability symptoms. Women with neurogenic causes for incontinence were excluded from the study. Stress incontinence resolved in 100% of geriatric and 97% of control women. Preoperative instability symptoms, including urge incontinence, improved in more than 50% of patients in both groups. De novo instability symptoms arose in 10% of women in each group but were generally controlled with anticholinergics. Efficient voiding resumed within a mean of 16 days in both groups. The morbidity and success rates of pubovaginal sling surgery in the elderly compare favorably to those in younger women. Advanced age alone would not dissuade us from constructing a pubovaginal sling when indicated.

Use of a pedicled rectus abdominis muscle flap sling in the treatment of complicated stress urinary incontinence

OBJECTIVE: A pedicled rectus muscle flap sling in the treatment of complicated stress urinary incontinence was evaluated. STUDY DESIGN: Thirty-two women underwent a combined vaginal and abdominal sling operation for stress incontinence with a pedicled muscle flap developed from the rectus abdominis muscle. All operations were performed jointly by the same two surgeons. The procedure involved transecting one rectus abdominis muscle just above its first tendinous intersection and isolating the muscle as a flap on its inferior vascular pedicle. The muscle flap was then swung beneath the urethra and bladder neck, pulled into the retropubic space on the contralateral side, and sewn to the obturator internus fascia or to Cooper's ligament. All patients undergoing the procedure had demonstrable stress incontinence on physical examination and underwent preoperative fluoroscopic video urodynamics. The diagnosis of complicated stress incontinence was based on the presence of one or more of the following factors: previous failed antiincontinence surgery (33 operations in 22 patients, average 1.5 operations), open vesical neck on fluoroscopy (14 patients), urethral closure pressure ≤30 cm H 2 O by the Brown-Wickham technique (16 patients), or massive vaginal prolapse and demonstrable stress incontinence with the prolapse reduced and the urethra supported in a normal position (16 patients). Follow-up ranged from 2 to 13 months (average 6 months). Surgical outcome was assessed by physical examination and a detailed telephone interview conducted by a physician who was not involved in the operations. RESULTS: Twenty-eight patients (87.5%) were satisfied with the results of the operation. There were four surgical failures (12.5%). Stress incontinence persisted in three patients after surgery, and one patient who had mixed incontinence before surgery was cured of stress incontinence but continued to have significant urinary leakage as a result of detrusor overactivity. There appears to be less voiding dysfunction with this technique than with other sling procedures for stress incontinence. CONCLUSIONS: The sling procedure with a rectus abdominis muscle flap appears to be a viable surgical technique in the treatment of complicated stress incontinence. Further study is needed to assess the long-term results of this operation and to evaluate its proper place in reconstructive pelvic surgery. (Am J Obstet Gynecol 1996;175:1460-6.)

Myocutaneous and muscle flaps: Refinements and new applications

OBJECTIVE: A pedicled rectus muscle flap sling in the treatment of complicated stress urinary incontinence was evaluated. STUDY DESIGN: Thirty-two women underwent a combined vaginal and abdominal sling operation for stress incontinence with a pedicled muscle flap developed from the rectus abdominis muscle. All operations were performed jointly by the same two surgeons. The procedure involved transecting one rectus abdominis muscle just above its first tendinous intersection and isolating the muscle as a flap on its inferior vascular pedicle. The muscle flap was then swung beneath the urethra and bladder neck, pulled into the retropubic space on the contralateral side, and sewn to the obturator internus fascia or to Cooper's ligament. All patients undergoing the procedure had demonstrable stress incontinence on physical examination and underwent preoperative fluoroscopic video urodynamics. The diagnosis of complicated stress incontinence was based on the presence of one or more of the following factors: previous failed antiincontinence surgery (33 operations in 22 patients, average 1.5 operations), open vesical neck on fluoroscopy (14 patients), urethral closure pressure ≤30 cm H2O by the Brown-Wickham technique (16 patients), or massive vaginal prolapse and demonstrable stress incontinence with the prolapse reduced and the urethra supported in a normal position (16 patients). Follow-up ranged from 2 to 13 months (average 6 months). Surgical outcome was assessed by physical examination and a detailed telephone interview conducted by a physician who was not involved in the operations. RESULTS: Twenty-eight patients (87.5%) were satisfied with the results of the operation. There were four surgical failures (12.5%). Stress incontinence persisted in three patients after surgery, and one patient who had mixed incontinence before surgery was cured of stress incontinence but continued to have significant urinary leakage as a result of detrusor overactivity. There appears to be less voiding dysfunction with this technique than with other sling procedures for stress incontinence. CONCLUSIONS: The sling procedure with a rectus abdominis muscle flap appears to be a viable surgical technique in the treatment of complicated stress incontinence. Further study is needed to assess the long-term results of this operation and to evaluate its proper place in reconstructive pelvic surgery. (Am J Obstet Gynecol 1996;175:1460-6.)

Pubovaginal Sling Procedure for Stress Incontinence

Urinary stress incontinence associated with poor urethral sphincter function and indicated by a urethral pressure of less than 10cm. water was treated in 52 cases with a pubovaginal autogenous fascial sling. No urethral sphincter function could be measured in 7 patients. Of these 52 patients 42 had undergone a previous operation for stress incontinence.The uninhibited detrusor dysfunction that accompanied the stress incontinence in 29 cases ceased after operation in 20 but persisted in 9. Postoperative urethral pressure measurements indicated that while the sling increased urethral pressure it did not cause an obstruction during voiding, since there was a measurable decrease in urethral pressure during a detrusor contraction.Urodynamic determinations were useful in patient selection, in the adjustment of sling tension at operation and in the assessment of reasons for failure. A satisfactory result with good urinary control was obtained in 50 cases and the procedure was a failure in 2.