C. Giberti et S. Rovida, Transvaginal bone-anchored synthetic sling for the treatment of stress urinary incontinence: An outcomes analysis, UROLOGY, 56(6), 2000, pp. 956-961
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.