Double-sling procedure for the surgical management of stress urinary incontinence with concomitant anterior vaginal wall prolapse.
OBJECTIVE
To assess the safety, efficacy of double-sling procedure (DS) for the surgical management of stress urinary incontinence (SUI) with concomitant anterior wall prolapse (AVWP) and to identify if less synthetic material implantation will decrease the complication rates without decreasing the high cure rates.


METHODS
We reviewed the women who underwent DS in two institutions from January 2009 to December 2013. In DS, there are two transobturator tapes inserted from two different routes for the surgical management of SUI with concomitant AVWP. POP-Q was used for anatomical evaluation of prolapse. SUI was assessed by cough stress test and ICIQ-SF questionnaire. We accepted that the patient was satisfied if the visual analog scale score was ≥80. The severity of urinary incontinence was classified by ICIQ-SF. The women were evaluated at the 3 and 12 months and annually.


RESULTS
A total of 74 women met the requirements for inclusion and had sufficient records for analysis. The mean follow-up period was 35.4 months (range 12-60). Operative time was 33.2 ± 6.2. The objective cure and subjective success rates of SUI were 87.8 and 93.2 %, respectively. The satisfaction from the surgery was also high with 86.5 % rate. The anatomical success in our series was rather high with 96 % rate. Our overall complication rate was 12.2 %. Mesh extrusion rate was 0 %.


CONCLUSIONS
Double-sling procedure is feasible, efficient, and safe. Reducing the mesh size did not have a detrimental effect on the outcomes of SUI treatment and simultaneous AVWP repair.
Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey. tyonguc@gmail.com.
Tarik
T
Yonguc
Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Ibrahim Halil
IH
Bozkurt
Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Volkan
V
Sen
Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Ozgu
O
Aydogdu
Department of Anatomy, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Goksin Nilufer
GN
Yonguc
Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Bulent
B
Gunlusoy
D000328:Adult; D000368:Aged; D004414:Dyspareunia / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D053825:Suburethral Slings / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D014596:Uterine Prolapse / Q000150:complications* / Q000601:surgery
Cystocele; Prolapse; Stress urinary incontinence; Surgical technique; Transobturator tape; Transvaginal mesh