title: Porcine small intestinal submucosa as a percutaneous mid-urethral sling: 2-year results.
abstract: OBJECTIVE
  To report the 2-year follow-up results on patients treated with a novel minimally invasive outpatient procedure for placing a mid-urethral sling, using porcine small intestinal submucosa (SIS).
  
  
  METHODS
  Thirty-four women with urodynamic evidence of stress urinary incontinence (SUI, 19) or of SUI with a positive cough test (15) were treated. A curved ligature carrier was used to create a tract between bilateral suprapubic stab incisions and a 2-cm mid-urethral vaginal incision. A suture secured to each end of the SIS sling was placed through the eyelet of the ligature carrier. Extraction was used to position the sling at the mid-urethra, providing a backboard of support that was remodelled with ingrowth of the patient's autologous tissue.
  
  
  RESULTS
  SUI was reportedly cured in 27 of the 34 women (79%) at the 2-year follow-up; three (9%) of those with no complete resolution were pleased with their results, because the improvement allowed them to wear an average one or fewer pads per day. One patient developed de novo urge incontinence. Three patients (9%) developed suprapubic inflammation at 10, 21 and 45 days after surgery; all resolved, but one had a recurrence of SUI. No prolonged retention, erosion or other complications were noted.
  
  
  CONCLUSIONS
  Early results with the percutaneous mid-urethral placement of SIS are promising and potentially comparable with those after using synthetic minimally invasive slings.
authors.affiliation: Section of Voiding Dysfunction and Female Urology, Cleveland Clinic Urological Institute, Cleveland, OH, USA. joness7@ccf.org
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Rackley
authors.forename: Ryan
authors.initials: R
authors.lastname: Berglund
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Abdelmalak
authors.forename: Gerard
authors.initials: G
authors.lastname: DeOrco
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
mesh_terms: D000818:Animals; D005260:Female; D006801:Humans; D007421:Intestine, Small; D008026:Ligation; D013536:Suture Techniques; D013552:Swine; D014521:Urethra / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*