title: Minimum 1-year results of mesh spiral-sling procedure in managing refractory and primary disabling stress urinary incontinence.
abstract: OBJECTIVE
  We present our minimum 1-year results with a mesh spiral-sling procedure (MSSP) for managing refractory and disabling stress urinary incontinence (SUI) in women.
  
  
  METHODS
  Thirty-four women were treated with MSSP between 2007 and 2011. Six had incomplete data and were excluded from analysis. Study cohort comprised 21 women with refractory (mean number of previous surgeries 2.2; range 1-6) and seen with primary disabling SUI. All patients had marked intrinsic sphincter deficiency (ISD) with a Valsalva leak-point pressure (VLPP) <60 cm H2O. Preoperative workup included assessing the impact of voiding symptoms using the International Consultation on Incontinence Questionnaire--Short Form (ICIQ-SF), estimating the daily number of pads, and urodynamic studies. Preoperative and postoperative findings were compared using the Wilcoxon signed-rank test.
  
  
  RESULTS
  Intraoperative unilateral bladder-neck perforation occurred in two women during dorsal urethrolysis. With a mean follow-up of 26 months (range 12-48), SUI was cured in 71.4% of patients. Distal urethral reconstruction with vaginal mucosal flaps was performed in two patients with short urethral length (<2.5 cm) due to recurrence of SUI 10 months after MSSP. Mean ICIQ-SF score decreased from 19.4 ± 3.6 preoperatively to 7.3 ± 2.8 postoperatively (p = 0.001). Mean daily pad number decreased from 5.2 preoperatively to 1.2 postoperatively (p = 0.02). Urethral or vaginal erosion was not observed in any case during follow-up.
  
  
  CONCLUSIONS
  Using spiral slings may be a viable option in managing refractory and disabling SUI.
authors.affiliation: Department of Urology, Bezmi Alem Vakıf University Hospital, Istanbul, Turkey.
authors.forename: Sinasi Yavuz
authors.initials: SY
authors.lastname: Önol
authors.forename: Osman
authors.initials: O
authors.lastname: Sevket
authors.forename: Fikret Fatih
authors.initials: FF
authors.lastname: Önol
authors.forename: Remzi
authors.initials: R
authors.lastname: Erdem
authors.forename: Abdülkadir
authors.initials: A
authors.lastname: Tepeler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016496:Incontinence Pads; D008875:Middle Aged; D012086:Reoperation; D053825:Suburethral Slings; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*