title: Spiral sling salvage anti-incontinence surgery for women with refractory stress urinary incontinence: surgical outcome and satisfaction determined by patient-driven questionnaires.
abstract: OBJECTIVE
  Female patients with refractory stress urinary incontinence (SUI) are a unique surgical challenge. They undergo multiple surgical procedures and eventually are left with urethral closure and continent diversion as their final option. We previously presented our initial experience of a technique that provides circumferential coaptation of the urethra in patients with severe urethral incompetence due to neurologic injuries or congenital anomalies. This study expands on that experience and reports on the clinical and quality of life of patients after spiral sling placement in a defined population of patients with refractory SUI.
  
  
  METHODS
  We prospectively evaluated 46 patients with refractory SUI who had undergone spiral sling placement. The surgical outcome was determined by clinical history and physical examination and, primarily, by patient self-assessment and included validated symptom, bother, and quality-of-life questionnaires.
  
  
  RESULTS
  Their mean age was 62 years. The mean follow-up was 15 months. At presentation, the patients had undergone a mean of 2.8 incontinence procedures and wore a mean of 5.5 pads daily. The mean pad use decreased to 1.3 pads daily (P <.05). Preoperatively, the mean severity and bother score from the SUI symptoms was 3.0 and 2.9, respectively (0, none; 3, severe). Postoperatively, these numbers decreased to 1.0 and 0.8 (P <.05). The mean overall improvement in symptoms was 82%. No perioperative complications developed. The procedure failed in 1 patient, who underwent urethral closure with urinary diversion. Two patients underwent repeat proximal spiral sling procedure.
  
  
  CONCLUSIONS
  The spiral sling is an effective salvage transvaginal procedure that can be considered for female patients with refractory SUI.
authors.affiliation: Institute of Urology, Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, Massachusetts 01805, USA. Arthur.Mourtzinos@lahey.org
authors.forename: Arthur
authors.initials: A
authors.lastname: Mourtzinos
authors.forename: Mary Grey
authors.initials: MG
authors.lastname: Maher
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; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000523:psychology / Q000601:surgery*