Is modified in situ vaginal wall sling operation the treatment of choice for recurrent genuine stress incontinence?

Purpose: We evaluate objectively the results of a modified in situ vaginal wall sling operation for recurrent genuine stress incontinence and whether it is a substitute for the traditional sling procedure. Materials and Methods: A total of 23 patients with urodynamically proved re current genuine stress urinary incontinence were recruited in this study. P atients were treated with a modified needle urethropexy technique using an island of in situ vaginal skin as a sling to support the bladder neck and u rethra. Surgical outcome was evaluated subjectively and objectively at a me dian of 15 months. A total of 42 patients who underwent a traditional polyt etrafluoroethylene sling operation served as controls. Results: The cure rate of the vaginal wall sling operation was 34.8% by obj ective assessment, which was lower than that of the traditional sling proce dure (88.1%, p <0.05). The subjective success rate demonstrated the same re sults (vaginal sling 60.9% versus traditional sling 92.9%, p <0.05). The ri sk factors for operation failure were lower maximal urethral pressure, lowe r urethral closing pressure, narrow vaginal capacity and previous anterior colporrhaphy or a Stamey operation (all p <0.05). In 3 cases suburethral ep ithelial inclusion cysts were specific complications of the operation. Ther e was no prolonged urinary retention or urethral erosion. Conclusions: Based on our results, we do not believe that the vaginal wall sling operation should be recommended for all recurrent genuine stress urin ary incontinence cases and especially not for those with factors predictive of surgical failure. Further studies are needed to investigate and clarify the possible causes of failure.