title: Mini-invasive collagen sling in the treatment of urinary incontinence due to sphincteric incompetence.
abstract: OBJECTIVE
  To assess the technical feasibility of mini-invasive sling procedure and present preliminary results in the treatment of urinary incontinence due to sphincteric insufficiency.
  
  
  METHODS
  Thirteen patients (6 males, 7 females, 8 with myelomeningocele, 1 with tethered spinal cord, 3 with bladder exstrophy, 1 with epispadias) underwent sling procedure with porcine dermis acellular collagen matrix (Pelvilace, Bard medical, UK). The median age was 15.5 (range 8.9-27.5) years. A suprapubic catheter was inserted for the measurement of leak point pressure during the operation. In females vaginal and in males perineal incision was used for sling insertion. The sling was introduced under cystoscopic control. The sling was not fixed with sutures. The outcomes were reviewed at 1, 6 and 12 month after the operation.
  
  
  RESULTS
  The median leak point pressure increased from 21.5 (range 5-25) cm H2O to 85 (range 70-100) cm H2O. At 1 month 8 and at 6 months 3 out of 13 patients were dry. At 12 months, none out of 11 patients was completely dry. However, at 12 months some improvement in incontinence was detected in 9 out of 11 patients. Two patients had primary failures. One patient got sling erosion to urethra after a tightening attempt. In one patient detrusor overactivity increased after the sling procedure.
  
  
  CONCLUSIONS
  Pelvilace sling is safe and easy to introduce in both males and females if pelvic floor anatomy is normal. Although immediate results were promising in neuropathic incontinence, the results seem to deteriorate to unacceptable low level already during the first year. In exstrophy patients the results are generally poor.
authors.affiliation: Hospital for Children and Adolescents, Helsinki University, Helsinki, Finland. seppo.taskinen@hus.fi
authors.forename: Seppo
authors.initials: S
authors.lastname: Taskinen
authors.forename: Riitta
authors.initials: R
authors.lastname: Fagerholm
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001672:Biocompatible Materials; D002648:Child; D003094:Collagen; D005109:Extracellular Matrix; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013552:Swine; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
chemical_list: D001672:Biocompatible Materials; D003094:Collagen