You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2010V171 SALVAGE SPIRAL SLING TECHNIQUES: ALTERNATIVES FOR THE MANAGEMENT OF DISABLING RECURRENT URINARY INCONTINENCE IN FEMALES Alejandro R. Rodriguez, Tariq Hakki, Jorge Caso, Raul Ordorica, and Jorge Lockhart Alejandro R. RodriguezAlejandro R. Rodriguez More articles by this author , Tariq HakkiTariq Hakki More articles by this author , Jorge CasoJorge Caso More articles by this author , Raul OrdoricaRaul Ordorica More articles by this author , and Jorge LockhartJorge Lockhart More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Females with recurrent stress urinary incontinence (SUI) following anti-incontinence surgery represent a therapeutic challenge. In our experience and that of others, standard sling procedures have failed to consistently correct these problems. In this video we are presenting a variety of spiral sling techniques that were used in these situations. METHODS Between January 2007 and July 2008, 30 female patients with persistent SUI following multiple failed anti-incontinence procedures were evaluated. The main indication for placement of a spiral sling included one or both of the following: 1.Failed previous anti-incontinence procedures with at least one prior sling placement and 2.ISD incontinence without concomitant urethral mobility. Preoperative evaluation included medical history, quality of life questionnaire, physical examination, urinalysis and culture, a Stamey score, cystoscopy, and video urodynamic assessment. The technique starts with a midline incision performed in the anterior vaginal wall approximately 1 cm away from the urethral meatus and carried down to the proximal urethra. The surgical procedure requires a circumferential dissection of the proximal urethra prior to sling placement. All the slings measured 1 x 16 cm. All the synthetic spiral slings (SSS) were polypropylene mesh with a zero polyglactin suture applied at each end. Slings were wrapped around the urethra to provide 360 degrees of compression prior to securing without tension. Patients were followed with number of pads, Stamey score, and quality of life questionnaires. RESULTS Twenty-nine patients were followed for a minimum of 15 months (15-18 months). Mean age was 60 years (36-84 years). At presentation, the mean number of prior vaginal procedures and pads used was 3.5 (1-6) and 7 (3-12), respectively. 21 had a synthetic spiral sling (SSS), 5 had an autologous spiral sling (AUSS)(3 rectus fascia and 2 fascia lata), and 3 underwent a lateral spiral sling (LSS). Mean daily pad use decreased to 0.9 (0-2) (p<0.05). Postoperative mean Stamey score decreased from 2.6 to 0.3 (p<0.05). Complications included 3 unilateral vesical perforations, in which the contralateral LSS was used. Overall success rate was 72%. CONCLUSIONS Salvage spiral sling techniques represent a satisfactory alternative for the treatment of refractory urinary incontinence. When synthetic material can not be used, autologous tissue can provide similar results. When the bladder is unilaterally perforated an LSS can be used on the contralateral side. Tampa, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e69 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandro R. Rodriguez More articles by this author Tariq Hakki More articles by this author Jorge Caso More articles by this author Raul Ordorica More articles by this author Jorge Lockhart More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...