Mersilene mesh sling: Short- and long-term clinical and urodynamic outcomes

OBJECTIVE: We sought to determine the long-term efficacy, safety, and urody namic effects of the Mersilene mesh suburethral sling in treating complicat ed forms of genuine stress incontinence. STUDY DESIGN: Two hundred women diagnosed with genuine stress incontinence, complicated by recurrence, intrinsic sphincter deficiency, or chronically increased intraabdominal pressure underwent a suburethral mesh sling proced ure (Mersilene; Ethicon Inc, Somerville, NJ). They were monitored with year ly clinical examinations plus short- and long-term postoperative urodynamic evaluations; statistical analysis was carried out by use of the Friedman 2 -way analysis by rank, Fischer-Freeman-H alton exact testing, analysis of v ariance for repeated measures, Wilcoxon, exact Mann-Whitney U test, and Bon ferroni paired t test. Of 176 patients who were 5 months or more postop, 12 7 (72%) had preoperative and short-term postoperative urodynamic evaluation s (range 5 to 23 months, mean 12.6 months). Fifty-two of 117 women who were more than 19 months postop (44%) completed preoperative and long-term post operative urodynamic evaluations at a mean of 63 months (range 20 to 107). One hundred thirty-six of 176 patients (77%) who were more than 4 months po stop had a short- and/or long-term postoperative urodynamic evaluation (ran ge 5 to 107 months, mean 30 months). RESULTS: Objective cure rate by stress test was 93% (126 of 136 patients) a t a mean of 30 months followup. The long-term objective cure rate was 94% ( 49 of 52). Subjectively, the short- and long-term cure rates were 95.3% and 90.4%, respectively. The cotton swab angle deflection decreased by a mean of 54 degrees at 1 year and 50 degrees at 5 years. Of the 10 failures, the mean preoperative cotton swab straining angle was 19.6 degrees, with 6 bein g < 30 degrees. Nineteen patients had a negative preoperative, cotton swab angle test result (mean straining angle 15 degrees before operation, -6 deg rees after operation) and a longterm cure rate of 67%. The objective cure r ate in patients with positive cotton swab angle results monitored long term (mean 62 months) was 100% (41 of 41). The postvoid residual increased by a mean of 25 mL short term and 10 mL long term. Thirty-eight patients (19%) had a total of 43 complications. Seven patients (3.5%) had long-term retent ion. De novo detrusor instability occurred in 12 patients (8.8%), although it was cured in 6 (4.4%). Eight patients (4%) had vaginal or inguinal sling erosion and were healed after revision, Delayed healing at the vaginal sli ng site responded completely to estrogen cream in two (1 %) patients. Five women had treatable vaginal stenosis, 5 had a local inguinal collection/inf ection unrelated to the mesh, and 3 required a 2-unit transfusion of packed red blood cells. One patient each had an entrapped nerve released, a cysto tomy repaired, or experienced thigh numbness or groin pain. CONCLUSIONS: The suburethral Mersilene mesh sling has a very high long-term objective and subjective cure rate in the treatment of complicated forms o f genuine stress incontinence. Frequent complications do occur but are reme diable. The 33% failure rate among patients with a preoperative negative co tton swab angle test result and the very low cotton swab straining angle am ong the 7% who had sling failures further confirms the widely held belief t hat sling urethropexy in the absence of hypermobility lacks efficacy.