Role of sling integrity in the restoration of leak point pressure in the rat vaginal sling model.
OBJECTIVE
We tested the hypothesis that cutting the sling at its suburethral section does not cancel its anti-incontinence effect. We also examined the long-term effects of the sling on bladder function in a recently validated rat model of vaginal sling.


METHODS
Stress urinary incontinence was created in 60 female Sprague-Dawley rats by the previously established method of bilateral pudendal nerve transection. Under anesthesia 20 animals received a vaginal sling, 20 received a vaginal sling in which the suburethral portion of the sling was cut immediately after placement and 20 received a sham vaginal sling. Six weeks after the procedures leak point pressure was determined and a cystometrogram was done using anesthesia in each animal via a previously implanted suprapubic catheter. Kruskal-Wallis and pairwise separate rank multiple comparison tests were performed with a significance level of 0.05.


RESULTS
The cut and intact slings increased leak point pressure similarly and these values were significantly higher than that of the sham sling (24.9 and 27.9 cm H2O, respectively, vs 20.7, p <0.0001). Peak micturition pressure was not significantly different among the 3 groups, indicating absent bladder outlet obstruction in the sling groups. Bladder compliance was significantly decreased 6 weeks after placement of a cut or intact sling compared with the sham sling (p = 0.007 and 0.05, respectively).


CONCLUSIONS
An intact suburethral portion is not a requirement for sling effectiveness in the rat model of stress urinary incontinence. However, the sling procedure decreases bladder compliance. This may explain the observed voiding dysfunction associated with sling procedures.
Hijaz
Adonis
A
Glickman Urological Institute, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Daneshgari
Firouz
F
Huang
Xiao
X
Bena
James
J
Liu
Guiming
G
Saffore
Lateef
L
Damaser
Margot
M
D000818:Animals; D023421:Models, Animal; D011312:Pressure; D019736:Prostheses and Implants; D051381:Rats; D017207:Rats, Sprague-Dawley; D001743:Urinary Bladder / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*