A FOLLOW-UP OF SILASTIC SLING FOR GENUINE STRESS-INCONTINENCE

Objective To assess the use of silastic sling for genuine stress incon tinence.Design Retrospective descriptive analysis. Setting Tertiary re ferral centre for urogynaecology. Subjects Eighty-eight women with uro dynamically proven genuine stress incontinence, 10 had coexistent detr usor instability. In 74 women, the sling operation was for recurrent i ncontinence. Intervention A low Pfannenstiel incision was used and a s uburethral tunnel dissected to insert the sling, which was attached un der minimal tension with non-absorbable sutures to each ileopectineal ligament. Main outcome measures Clinical and urodynamic data were asse ssed between two and three months post-surgery; thereafter clinical as sessment and pad testing were performed at yearly intervals for five y ears. Results The subjective cure at three months was 81% and the obje ctive cure was 69%. There was a fall in success rate with increasing n umber of continence operations, and this was statistically significant for women with three or more previous continence operations (P < 0.05 ). Neither age, parity nor menopausal status made a statistical differ ence to the cure rate. Twenty-three women had reached their fifth year follow up and the success rate using life table analysis was 71%. Pos t-operatively, 29 women had detrusor instability: 22 women developed d etrusor instability de novo and seven had detrusor instability presurg ery. Urodynamic findings postsurgery showed an increase (P < 0.001) in outflow resistance. Four women required removal of sling for voiding difficulties. Ten women developed sling erosions: five vaginal, four b ladder erosions and one urethral erosion. After removal of the sling, seven women still remained continent. Conclusions A silastic sling ope ration for the treatment of genuine stress incontinence provides a goo d long term cure, considering that 45% of women had two or more previo us failed continence operations. The high prevalence of detrusor insta bility and voiding difficulties postsurgery should be noted.