Pubovaginal sling technique utilizing a unique bone anchor instrumentation system.

Abstract

INTRODUCTION: In the past, the pubovaginal sling (PVS) technique was originally delegated for the treatment of intrinsic sphincter deficiency syndrome (ISD). Today, it has not only undergone a revitalization, but is being recommended for the treatment of all forms of stress urinary incontinence (SUI) as well as the ISD syndrome. In an attempt to combine the best features of the traditional approach plus add the benefits of simplicity, reduction of costs, morbidity, and rapid return to patient normality, a new variation of the PVS has been developed. The technique utilizes pre-threaded bone anchors to which either a natural fascia or pre-prepared cadaveric fascia can be anchored. MATERIAL AND METHODS: This study consists of 78 female patients treated between September 1997 and December 1998 with our PVS procedure. The patient population spans the spectrum of pure stress incontinence, with or without associated pelvic relaxation defects, pure ISD group and lastly, those individuals who suffered from both anatomical incontinence and overactive bladder syndrome. In our 72 evaluable patients, the results as of this publication are: an overall cure rate of 86% with an additional 11% improved and 3% failure. The following text describes in detail the patient population, the surgical technique, the final results, complications, and patient satisfaction scores. Also included is a short review of the literature documenting several other techniques utilizing bone anchoring fixation devices. CONCLUSION: A simplification of the true-and-tried PVS is described which provides the surgeon with a new and exciting methodology for the treatment of all forms of hypermobility, i.e. stress incontinence, as well as the intrinsic sphincter deficiency syndrome. At the same time the surgical learning curve, patient morbidity, and hospital stay are decreased; without compromising total surgical outcome.