THE INTRAVAGINAL SLINGPLASTY OPERATION, A MINIMALLY INVASIVE TECHNIQUE FOR CURE OF URINARY-INCONTINENCE IN THE FEMALE

The aim was to evaluate the intravaginal slingplasty operation, a mini mally invasive technique for cure of urinary incontinence. Fifty-four unselected patients, aged from 26 to 79 years, mainly with mixed incon tinence symptoms, underwent this procedure. It works by tightening the suburethral vagina ('hammock'), and by creating an artificial puboure thral neoligament. Where indicated, repair of uterine prolapse (24 cas es), or infracoccygeal sacropexy (17 cases) was also performed. Almost all patients were discharged on the day of, or day after surgery, wit hout requirement for postoperative catheterization, and returned to fa irly normal activities, including jobs, within 7 to 14 days. At a mean follow-up time of 15 months, the cure rates for preoperative symptoms were, frequency 88%, nocturia 77%, urge incontinence 89%, stress inco ntinence (SI) 85%, symptoms of abnormal emptying, 77%, and reduction o f mean residual urine from 67.5 mL to 32 mL. The objective cure rate ( exercise pad testing) for stress incontinence was 88.6%; taking the gr oup as a whole, urine loss was reduced from a mean of 11.6 g preoperat ively to a mean of 0.5 g postoperatively. Urodynamically diagnosed det rusor instability was not a predictor of surgical failure in this stud y. According to the concepts presented here, symptoms of urinary dysfu nction are mainly symptomatic manifestations of abnormal laxity in the vagina or its supporting ligaments. The surgical methods used to corr ect these defects are fairly simple, safe and easily learnt by any pra ctising gynaecologist.