Pubovaginal sling using polypropylene mesh and Vesica bone anchors.
OBJECTIVE
To report preliminary results from a modified pubovaginal sling procedure using polypropylene mesh as the sling suspended by nonabsorbable sutures anchored to the pubic tubercle with Vesica bone anchors.


METHODS
Thirty-five women with type III stress urinary incontinence (SUI) (with or without associated urethral hypermobility) or type II SUI with additional risk factors such as obesity, chronic obstructive pulmonary disease, or failed prior incontinence-correcting procedures underwent this modified pubovaginal sling procedure. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys.


RESULTS
With a mean follow-up of 8.4 months (range 2 to 18), 32 women (91.4%) were dry, 1 improved, and 2 remained incontinent. The pubovaginal sling procedure was the only operation performed in 46% of patients, with a mean operative time of 72 minutes, a mean estimated blood loss of 137 mL, and a mean hospital period of 2.3 days. Patients on whom concomitant gynecologic procedures were performed had a mean duration of surgery of 122 minutes, a mean estimated blood loss of 202 mL, and a mean hospitalization period of 2.9 days. Thirteen women had preoperative urgency that persisted in 31% of patients. De novo urgency developed in 3 patients. Seven women required prolonged suprapubic tube drainage but no patient remained in permanent retention. There has been no infection or erosion.


CONCLUSIONS
Our experience with this modified pubovaginal sling procedure using polypropylene mesh and Vesica bone anchors showed excellent results with greater technical ease, minimal morbidity, and decreased hospitalization period when compared to a traditional pubovaginal sling performed in our hands. Additional follow-up will be needed to assess long-term efficacy.
Hom
D
D
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
Desautel
M G
MG
Lumerman
J H
JH
Feraren
R E
RE
Badlani
G H
GH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001858:Bone Nails; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011126:Polypropylenes; D011630:Pubic Bone / Q000601:surgery; D012307:Risk Factors; D013526:Surgical Mesh; D013536:Suture Techniques; D017211:Treatment Failure; D014522:Urethral Diseases / Q000150:complications; D001743:Urinary Bladder / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D016055:Urinary Retention / Q000209:etiology / Q000628:therapy; D014554:Urination / Q000502:physiology; D014621:Vagina
D011126:Polypropylenes