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How to achieve long-term success in the treatment of female urinary stress incontinence? Novel modification on vaginal sling.

Mustafa M - Korean J Urol (2011)

Bottom Line: The surgical technique was successful in 22 patients (95.65%); 20 of them were cured and 2 patients showed clinical improvements.No significant post-voiding residue was detected postoperatively.Cost-effectiveness and a low risk of urethral erosion, due to the presence of intervening vaginal mucosa, are important advantages of this technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Osmaniye State Hospital, Osmaniye, Turkey.

ABSTRACT

Purpose: Modest long-term success is one of the most disappointing issues facing patients undergoing anti-incontinence surgery. Herein we introduce a novel surgical modification of the vaginal sling to address the mechanisms that may lead to a reduction in the success rate at the long-term follow-up.

Materials and methods: Twenty-three female patients with mean age of 48.2 years (range, 22-73 years) underwent anti-incontinence surgery to correct their stress urinary incontinence (SUI) between August 2006 and January 2008. The in situ anterior vaginal wall sling, reinforced with equi-size monofilament polypropylene tape, was used as an anti-incontinence surgical procedure. The mean follow-up period was 30.2 months (range, 24-38 months).

Results: The surgical technique was successful in 22 patients (95.65%); 20 of them were cured and 2 patients showed clinical improvements. Urinary retention was observed in one patient (4.34%), which was resolved after decreasing the tension of the suspension sutures. No significant post-voiding residue was detected postoperatively.

Conclusions: Cost-effectiveness and a low risk of urethral erosion, due to the presence of intervening vaginal mucosa, are important advantages of this technique. Long-term success is expected, because relaxation of the non-tension-free suspension sutures and dislocation of the midurethral sling are less likely.

No MeSH data available.


Related in: MedlinePlus

Schematic illustration of the placard-shaped incision made at the anterior vaginal wall before starting dissection.
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Figure 1: Schematic illustration of the placard-shaped incision made at the anterior vaginal wall before starting dissection.

Mentions: With the patient in the lithotomy position, an 18 F catheter was inserted and the bladder was evacuated. Then placard incision (Fig. 1) at the anterior vaginal wall was performed and dissection of the vaginal flap was carried out to prepare for the midurethral in situ anterior vaginal wall sling (width 1 cm, length 2 cm) (Fig. 2). The length of the midline incision was made according to the degree of cystocele (the transvaginal surgical procedure was used correct cystocele). The dissection at the lateral side of the in situ sling was carried out until the index figure could be felt easily from the suprapubic area. Equi-size monofilament polypropylene mesh (I STOP CL Medical France) was then prepared at the lateral side of the placard incision, 2 suspension sutures of 1/0 polypropylene were inserted in the flap and the mesh (Fig. 3), and using controlled pressure the needle was elevated through the endopelvic fascia, into the space of Retzius, through the rectus muscles, and through the previously created suprapubic skin incision. Two fixation sutures were placed at the lower and upper edges of the in situ sling to keep the mesh over the sling and prevent the dislocation of the mesh (Fig. 3). Before fixation of the suspension sutures to the symphysis pubis periosteum, the bladder was filled with 300 ml isotonic solution and manual pressure was applied to the suprapubic area to test for leakage, thus adjusting the tension of the sutures. Then closure of the placard incision over the in situ sling was done. Intra-operative cystoscopy was done for all patients to rule out urethral or bladder injury. At the end of the operation, a vaginal sponge with Betadine solution and antibacterial cream was placed and left for one night postoperatively. The Foley catheter was removed at 5 to 7 days postoperatively. The mean follow-up period was 30.2 months (range, 24-38 months). Sexual intercourse and carrying heavy weights were avoided for 2 months postoperatively. The absence of a significant post-voiding residual urine (PVR) (50 cc or less was consider insignificant) at the postoperative period was assessed by using real abdominal ultrasound. Postoperative follow-up measures included pelvic physical examination, history of incontinence, stress test, and measurement of PVR. Postoperative cure of SUI was defined as the absence of complaint of leakage and the absence of urine incontinence on stress testing. Improvement was defined as no loss of urine with stress and patient reports of some leakage but overall satisfaction. Persistence of incontinence was considered as failure.


How to achieve long-term success in the treatment of female urinary stress incontinence? Novel modification on vaginal sling.

Mustafa M - Korean J Urol (2011)

Schematic illustration of the placard-shaped incision made at the anterior vaginal wall before starting dissection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3065130&req=5

Figure 1: Schematic illustration of the placard-shaped incision made at the anterior vaginal wall before starting dissection.
Mentions: With the patient in the lithotomy position, an 18 F catheter was inserted and the bladder was evacuated. Then placard incision (Fig. 1) at the anterior vaginal wall was performed and dissection of the vaginal flap was carried out to prepare for the midurethral in situ anterior vaginal wall sling (width 1 cm, length 2 cm) (Fig. 2). The length of the midline incision was made according to the degree of cystocele (the transvaginal surgical procedure was used correct cystocele). The dissection at the lateral side of the in situ sling was carried out until the index figure could be felt easily from the suprapubic area. Equi-size monofilament polypropylene mesh (I STOP CL Medical France) was then prepared at the lateral side of the placard incision, 2 suspension sutures of 1/0 polypropylene were inserted in the flap and the mesh (Fig. 3), and using controlled pressure the needle was elevated through the endopelvic fascia, into the space of Retzius, through the rectus muscles, and through the previously created suprapubic skin incision. Two fixation sutures were placed at the lower and upper edges of the in situ sling to keep the mesh over the sling and prevent the dislocation of the mesh (Fig. 3). Before fixation of the suspension sutures to the symphysis pubis periosteum, the bladder was filled with 300 ml isotonic solution and manual pressure was applied to the suprapubic area to test for leakage, thus adjusting the tension of the sutures. Then closure of the placard incision over the in situ sling was done. Intra-operative cystoscopy was done for all patients to rule out urethral or bladder injury. At the end of the operation, a vaginal sponge with Betadine solution and antibacterial cream was placed and left for one night postoperatively. The Foley catheter was removed at 5 to 7 days postoperatively. The mean follow-up period was 30.2 months (range, 24-38 months). Sexual intercourse and carrying heavy weights were avoided for 2 months postoperatively. The absence of a significant post-voiding residual urine (PVR) (50 cc or less was consider insignificant) at the postoperative period was assessed by using real abdominal ultrasound. Postoperative follow-up measures included pelvic physical examination, history of incontinence, stress test, and measurement of PVR. Postoperative cure of SUI was defined as the absence of complaint of leakage and the absence of urine incontinence on stress testing. Improvement was defined as no loss of urine with stress and patient reports of some leakage but overall satisfaction. Persistence of incontinence was considered as failure.

Bottom Line: The surgical technique was successful in 22 patients (95.65%); 20 of them were cured and 2 patients showed clinical improvements.No significant post-voiding residue was detected postoperatively.Cost-effectiveness and a low risk of urethral erosion, due to the presence of intervening vaginal mucosa, are important advantages of this technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Osmaniye State Hospital, Osmaniye, Turkey.

ABSTRACT

Purpose: Modest long-term success is one of the most disappointing issues facing patients undergoing anti-incontinence surgery. Herein we introduce a novel surgical modification of the vaginal sling to address the mechanisms that may lead to a reduction in the success rate at the long-term follow-up.

Materials and methods: Twenty-three female patients with mean age of 48.2 years (range, 22-73 years) underwent anti-incontinence surgery to correct their stress urinary incontinence (SUI) between August 2006 and January 2008. The in situ anterior vaginal wall sling, reinforced with equi-size monofilament polypropylene tape, was used as an anti-incontinence surgical procedure. The mean follow-up period was 30.2 months (range, 24-38 months).

Results: The surgical technique was successful in 22 patients (95.65%); 20 of them were cured and 2 patients showed clinical improvements. Urinary retention was observed in one patient (4.34%), which was resolved after decreasing the tension of the suspension sutures. No significant post-voiding residue was detected postoperatively.

Conclusions: Cost-effectiveness and a low risk of urethral erosion, due to the presence of intervening vaginal mucosa, are important advantages of this technique. Long-term success is expected, because relaxation of the non-tension-free suspension sutures and dislocation of the midurethral sling are less likely.

No MeSH data available.


Related in: MedlinePlus