Transvaginal bone-anchored synthetic sling for the treatment of stress urinary incontinence: an outcomes analysis.
OBJECTIVE
To evaluate the results and complications of a new transvaginal minimally invasive procedure for the treatment of stress urinary incontinence.


METHODS
Sixty-seven women aged 37 to 77 years underwent a pervaginal bone-anchoring synthetic sling procedure between April 1997 and February 1999. Sixty-three patients had a defect of the anatomic support, and 4 had iatrogenic 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 provider. The questionnaire inquired about urine leakage, obstructive and irritative symptoms, quality of life, and satisfaction with the treatment received. The physician and questioner had no knowledge of each other.


RESULTS
Mean follow-up was 17 months. Perfect dryness was seen in 82% of patients with improvement in 9% and failure in 9%. Patients reporting a failed outcome were significantly older than those reporting improvement or cure (P = 0.01). All patients with ISD failed. Moderate obstructive symptom scores 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 failed patients, respectively (P <0.001). Three percent of patients experienced pain during intercourse. Mild pelvic pain was found in 8% of patients. The only main complication of the operation was the vaginal erosion and sling removal in 16% of patients. Seventy-two percent of patients were completely satisfied with the treatment received.


CONCLUSIONS
This procedure allows a high cure rate in patients with urinary incontinence due to a defect of anatomic support, and it is unsuitable when 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 nonsynthetic materials may be advisable.
Giberti
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Division of Urology, San Paolo Hospital, Savona, Italy.
Rovida
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D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011630:Pubic Bone / Q000601:surgery*; D013523:Surgical Equipment / Q000009:adverse effects; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014621:Vagina / Q000601:surgery*; D014623:Vaginal Diseases / Q000209:etiology