UROLOGICAL SURVEY
NEUROLOGY & FEMALE UROLOGY
Salvage spiral sling techniques: alternatives to manage disabling recurrent urinary incontinence in females
Rodriguez AR; Hakky T; Hoffman M; Ordorica R; Lockhart J
Department of Urology, University of South Florida and Tampa General Hospital, Tampa, Florida, USA
J Urol. 2010; 184: 2429-33
PURPOSE: Females with recurrent stress urinary incontinence after anti-incontinence surgery represent a therapeutic challenge. In our experience and that of others standard sling procedures have occasionally failed to correct these problems. We determined the effectiveness of various spiral sling techniques used in these cases to manage pipe stem urethras in which conventional slings had failed.
MATERIALS AND METHODS: Between January 2007 and July 2008 we evaluated 30 female patients with persistent stress urinary incontinence after multiple failed anti-incontinence procedures. Preoperative and postoperative evaluation consisted of history, physical examination, number of pads, Stamey score and quality of life questionnaires.
RESULTS: We followed 28 patients a minimum of 15 months (range 15 to 18). Mean patient age was 60 years (range 36 to 84). At presentation patients had undergone a mean of 3.5 prior vaginal procedures (range 1 to 6) and used a mean of 7 pads daily (range 3 to 12). Of the patients 21 received a synthetic spiral sling, 5 received an autologous spiral sling (rectus fascia in 3 and fascia lata in 2) and 3 received a lateral spiral sling. Mean pad use decreased to 0.9 daily (range 0 to 2, p<0.05). Postoperative mean Stamey score decreased from 2.6 to 0.3 (p<0.05). Complications included unilateral vesical perforation in 3 patients with a contralateral lateral spiral sling. The overall success rate was 72%.
CONCLUSIONS: Salvage spiral sling techniques are a satisfactory alternative treatment for refractory stress urinary incontinence. When synthetic material cannot be used, autologous tissue can provide similar results. When the bladder is perforated unilaterally, a lateral spiral sling can be used on the contralateral side.
EDITORIAL COMMENT
This paper discusses the use of a salvage spiral urethral sling in a very difficult to treat patient population, that is, females who have failed multiple vaginal operations for urinary incontinence. The authors provide an excellent technical analysis and state that when using this technique they are able to salvage approximately three out of four. Of interest is that they describe the use of both autologous fascia as well as synthetic graft. Operative tactics are described in the event of a bladder injury at the time of dissection (laterally placed spiral sling); this is very valuable in view of the potential for injury during the periurethral dissection in this patient population with a history of multiple surgeries. In addition, the authors discuss the use of this operation as opposed to the use of artificial urinary sphincter. Given the success rate of this operation mirrors that reported for artificial urinary sphincter in female patients, it has a potential to achieve a great deal of popularity in this very difficult to treat population (1).
Dr. Steven P. Petrou
Professor of Urology, Associate Dean
Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu
- 1. Thomas K, Venn SN, Mundy AR: Outcome of the artificial urinary sphincter in female patients. J Urol. 2002; 167: 1720-2.
Publication Dates
-
Publication in this collection
30 Mar 2011 -
Date of issue
Feb 2011
