title: Spiral sling salvage anti-incontinence surgery in female patients with a nonfunctional urethra: technique and initial results.
abstract: OBJECTIVE
  Female patients with severe urethral incompetence are a unique surgical challenge. Urethral closure and continent diversion are often the next step in the treatment of these patients. We present a technique that provides circumferential coaptation of the urethra as a salvage procedure in this severe subset of patients.
  
  
  METHODS
  We prospectively evaluated 47 patients who had a spiral sling. A 1 x 15 cm piece of soft polypropylene mesh was prepared with a zero polyglactin suture applied at each end. A clamp was used to pass the mesh between the urethra and pubis. The ends of the mesh were crossed at the ventral aspect of the urethra, creating a complete circle around the urethra. The sutures were transferred to the suprapubic area and tied without tension. The surgical outcome was determined by patient self-assessment, including symptom, bother and quality of life questionnaires.
  
  
  RESULTS
  Mean patient age was 59 years. At presentation patients had undergone a mean of 2.6 incontinence procedures and wore a mean of 6 pads daily. Mean daily pad use decreased to 0.9 (p <0.005). Preoperatively mean SUI symptom severity and bother scores were 2.8 and 2.9, respectively, on a scale of 0--none to 3--severe. Postoperatively these values decreased to 0.6 and 0.4, respectively (each p <0.005). There was a mean 87% overall improvement in symptoms.
  
  
  CONCLUSIONS
  The spiral sling is an effective salvage transvaginal procedure that may be considered in a small subset of female patients with a nonfunctional urethra as a last resort before urethral closure procedures.
authors.affiliation: Department of Urology, Columbia University School of Medicine, New York, New York, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Rutman
authors.forename: Donna Y
authors.initials: DY
authors.lastname: Deng
authors.forename: Sovrin M
authors.initials: SM
authors.lastname: Shah
authors.forename: Shlomo
authors.initials: S
authors.lastname: Raz
authors.forename: Larissa V
authors.initials: LV
authors.lastname: Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D011446:Prospective Studies; D019736:Prostheses and Implants; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
chemical_list: D011126:Polypropylenes