Transvaginal bone-anchored synthetic sling for the treatment of stress urinary incontinence: An outcomes analysis

Objectives. To evaluate the results and complications of a new transvaginal minimally invasive procedure for the treatment of stress urinary incontine nce. Methods. Sixty-seven women aged 37 to 77 years underwent a pervaginal bone- anchoring synthetic sling procedure between April 1997 and February 1999. S ixty-three patients had a defect of the anatomic support, and 4 had iatroge nic intrinsic sphincteric deficiency (ISD). Patients were assessed at least 1 year postoperatively, underwent physical examination, and filled in the self-assessment questionnaire with the help of a nonpartisan health care pr ovider. The questionnaire inquired about urine leakage, obstructive and irr itative symptoms, quality of life, and satisfaction with the treatment rece ived. The physician and questioner had no knowledge of each other. Results. Mean follow-up was 17 months. Perfect dryness was seen in 82% of p atients with improvement in 9% and failure in 9%. Patients reporting a fail ed outcome were significantly older than those reporting improvement or cur e (P = 0.01). All patients with ISD failed. Moderate obstructive symptom sc ores have been noticed in 31% of patients. Irritative voiding symptoms have been recorded in 22% of cured patients and 83% and 80% of improved and fai led patients, respectively (P < 0.001). Three percent of patients experienc ed pain during intercourse. Mild pelvic pain was found in 8% of patients. T he only main complication of the operation was the vaginal erosion and slin g removal in 16% of patients. Seventy-two percent of patients were complete ly satisfied with the treatment received. Conclusions. This procedure allows a high cure rate in patients with urinar y incontinence due to a defect of anatomic support, and it is unsuitable wh en incontinence is due to ISD. The only main complication came from the use of the gelatin-coated Dacron sling that resulted in vaginal erosion, often necessitating the sling removal. The use of different synthetic or nonsynt hetic materials may be advisable. UROLOGY 56: 956-961, 2000. (C) 2000, Else vier Science Inc.