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Results for “Suburethral Slings”

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At least 127 records · Page 7Linked to original sources

PubMed2005

Impact of vaginal surgery for stress urinary incontinence on female sexual function: is the use of polypropylene mesh detrimental?

OBJECTIVES: To evaluate prospectively the impact of a distal urethral polypropylene sling on sexual function using a validated questionnaire. Suburethral slings are currently the most common anti-incontinence surgery performed. Although the use of polypropylene is safe and effective, concern exists that the presence of the material in the vagina may adversely affect sexual function. METHODS: A total of 29 patients agreed to participate in this prospective study. The patients were evaluated with the Female Sexual Function Index, a validated, 19-item questionnaire that assesses six domains of sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. The questionnaires were administered at 6-month intervals during the follow-up visits. RESULTS: The mean patient age was 52 years (range 38 to 72). The mean duration of follow-up was 19.4 months (range 7 to 37). No statistically significant difference was found in sexual function after placement of a distal urethral polypropylene sling. Of the 29 patients, 14% were not sexually active before or after surgery. No statistically significant difference was found between preoperative and postoperative desire, arousal, lubrication, orgasm, satisfaction, and pain. CONCLUSIONS: No change was found in overall sexual function in women undergoing placement of a mid to distal polypropylene urethral sling. Specifically, neither a deleterious effect nor statistically significant improvement was found in sexual desire, arousal, lubrication, orgasm, satisfaction, or pain compared with the preoperative baseline values.

Adult↗

PubMed1996

Sling transection of urethra: a rare complication.

Common postoperative complications associated with suburethral sling procedures include voiding disorders and urinary retention, de novo development of detrusor instability, sling graft rejection and, rarely, erosion of the graft into the urethra. The authors present a case of a late postoperative complication of polytetrafluoroethylene graft erosion and partial transection of the urethra, with resultant acute urinary retention. A 50-year-old patient presented with acute urethral outflow obstruction due to sling graft erosion into the urethra nearly 2 years after she underwent a curative sling procedure for recurrent genuine stress incontinence. After relieving the acute urinary retention by inserting a suprapubic catheter under ultrasound guidance, the sling graft was accessed and removed. The urethral defect was repaired successfully. At follow-up 5 months later, the patient was continent subjectively and by urodynamic criteria, with no voiding abnormalities. Although erosion of the sling graft into the urethra and transection of this structure is a rare complication after a sling procedure, it should be considered in the patient who experiences progressive voiding difficulties, has transvaginal urinary leakage, and/or cannot be catheterized transurethrally. Expedient relief of the urinary retention and outflow obstruction is necessary, as well as careful surgical reconstruction of the urethra. To minimize the development of this complication we recommend plication of paraurethral connective tissue in the midline beneath the sling graft, and placement of minimal tension on the sling.

Female↗

PubMed2001

Sonographic evaluation of anatomic results after the pubovaginal sling procedure for stress urinary incontinence.

OBJECTIVE: To investigate the anatomic changes after the pubovaginal sling procedure in women with stress urinary incontinence by transrectal sonography METHODS: This study enrolled 56 women with varying types of stress urinary incontinence who were treated with the pubovaginal sling procedure using self-fashioned polypropylene mesh. The suburethral sling was fixed without tension and was placed at the position between the bladder neck and the proximal urethra. The patients were investigated preoperatively and postoperatively by transrectal sonography of the bladder and urethra. RESULTS: At a median follow-up of 24 months (range, 6-39 months), 48 patients (85.7%) were cured, 6 (10.7%) had improved, and 2 (3.6%) had treatment failures. Transrectal sonography revealed a well-suspended bladder neck and proximal urethra in all patients who were cured. As measured by changes of the axis of the pubovesical ligament, the position of the bladder neck was elevated by a mean of 29.6 +/- 21.5 degrees in the resting condition and 47.4 +/- 27.7 degrees in the straining condition. An incompetent bladder neck and proximal urethra were noted in 8 patients who had stress urinary incontinence after surgery. The incidence of opening of the bladder neck was 84.6% in 13 patients with de novo urgency or urge incontinence, whereas only 2 (4.7%) of 43 patients who did not have postoperative urgency had opening of the neck (P = .000). CONCLUSION: Transrectal sonography provides useful information about anatomic changes after the pubovaginal sling procedure. Bladder neck incompetence after surgery was closely related to postoperative urgency or urge incontinence.

Adult↗

PubMed2002

The use of porcine dermal implant in a minimally invasive pubovaginal sling procedure for genuine stress incontinence.

OBJECTIVE: To assess the outcome of a suburethral sling using a porcine dermal implant (Pelvicoltrade mark, Bard Urology, UK) in the surgical management of urinary stress incontinence. PATIENTS AND METHODS: Forty women with urodynamically confirmed genuine stress incontinence were recruited into the study and followed up at 6 weeks and at least 6 months (mean 12 months, range 6-18). The sling was inserted using a minimal-access technique, which allowed 23 women to be operated as day-cases. Outcome measures included continence rates, voiding dysfunction, satisfaction scores and whether the patients would recommend the operation to a friend or relative. RESULTS: The cure rate was 85%, with sustained benefit; a further 10% of the women were improved by surgery. Voiding dysfunction rates were low and satisfaction scores high. Most women would undergo the procedure again if they became incontinent in the future and would recommend the procedure to a friend or relative. CONCLUSION: A minimal access pubovaginal sling using Pelvicoltrade mark is effective in treating stress incontinence. The complication rate is low and the procedure can be performed as a day-case with no loss of efficacy.

Adult↗

PubMed1979

Fascia lata urethrovesical suspension for recurrent stress urinary incontinence.

Although the physiologic mechanisms of normal micturition in the female subject are not fully understood, it is generally believed that urinary continence is maintained by a competent urethrovesical neck. Unfortunately, the patient who has had multiple operations for recurrent stress urinary incontinence often has a urethra that is shortened and fixed in scar tissue. In such patients, anterior colporrhaphy with operative release of the periurethral fibrosis and plication of the endopelvic fascia to create a functionally more normal urethrovesical junction will increase the chances for good results. A fascia lata support of the proximal 1 to 2 cm of the urethra ensures continued elevation of the urethra and with stress the sling provides a pulling-up effect. Fifty patients with a suburethral sling procedure are presented in detail. Forty-seven of these patients had a total of 121 prior operative procedures for stress urinary incontinence. Urologic studies are outlined. Forty-two patients (84%) were continent postoperatively, five were improved, and three had failures. Operative technique and complications are discussed.

Adult↗

PubMed2005

An update on slings.

PURPOSE OF REVIEW: The aim of this article is to review the year's literature on the treatment of female incontinence with suburethral slings. RECENT FINDINGS: The use of slings to treat female stress urinary incontinence has had resurgence with new surgical techniques. The tension-free vaginal tape created in 1996 was the basis of most of the studies performed over the past year. The device was compared with more traditional surgical techniques as well as new techniques such as the trans-obturator tape. In addition the tension-free vaginal tape was examined in women with pelvic organ prolapse and older in age. The complications of the device are well known and several studies recounted these with an attempt to predict patients who will have success. Modifications to surgical technique are described to improve patient results as well as further analysis of outcomes with post-surgical urodynamic-based studies. SUMMARY: The majority of papers center on the tension-free vaginal tape and comparing other methods of incontinence surgery with the tape's success. With 7-year data, the device has secured its place in the treatment of female stress incontinence. Newer methods are being explored and are now compared with the tension-free vaginal tape's outcomes.

Female↗

PubMed2005

Comparison of long-term outcomes of autologous fascia lata slings with Suspend Tutoplast fascia lata allograft slings for stress incontinence.

OBJECTIVE: This study was undertaken to compare the objective and subjective long-term surgical outcomes in patients receiving Tutoplast fascia lata allograft slings with those receiving autograft slings for the treatment of stress urinary incontinence (SUI). STUDY DESIGN: We reviewed all patients (n = 71) undergoing suburethral sling with either autologous fascia lata (n = 39) or Tutoplast fascia lata (n = 32) for urodynamic stress incontinence (USI) from October 1, 1998, to August 1, 2001. RESULTS: Of the original 71 patients, 47 were evaluated by objective and/or subjective means at a minimum of 2 years after surgery. Subjective quality of life measures, subjective continence, maximum urethral closure pressure, and bladder neck mobility were not different between the 2 groups. USI was demonstrated in 41.7% of allograft patients compared with no autograft patients (P = .007). CONCLUSION: Although patient reported cure of SUI is high for both sling types, USI recurs at a significantly higher rate in Tutoplast slings compared with autologous slings.

Aged↗

PubMed2004

Foley versus intermittent self-catheterization after transvaginal sling surgery: which works best?

OBJECTIVES: To determine whether the duration of catheter use differed between subjects using clean intermittent self-catheterization and those using continuous Foley catheterization after transvaginal sling surgery. METHODS: We performed a retrospective analysis of postoperative bladder drainage in 167 consecutive women undergoing transvaginal suburethral sling placement for stress urinary incontinence. The primary outcome measure was the duration of catheter use. Normal voiding was defined as a voided volume equal to twice the residual volume and a residual volume of less than 100 mL for 24 hours. The groups were compared for differences in demographic, preoperative, and postoperative variables using univariate and multivariate analyses. The potential confounding effects of age, concomitant procedures, sling material, preoperative Valsalva voiding, and voiding pressures were investigated using general linear models. RESULTS: A total of 122 subjects used clean intermittent self-catheterization and 45 had Foley catheter drainage. No differences were found between the groups in terms of concomitant procedures performed and preoperative diagnoses. The median duration of catheter use was 12 days (range 1 to 120) for women using clean intermittent self-catheterization versus 8 days (range 1 to 120) for those using Foley catheter drainage (P = 0.026). This difference was not influenced by age, concomitant procedures, sling material, preoperative Valsalva voiding, or preoperative voiding pressures according to the multivariate analyses. CONCLUSIONS: Although many advocate bladder retraining for postoperative bladder rehabilitation, continuous bladder drainage may result in quicker recovery of normal voiding after sling procedures.

Aged↗

PubMed1990

Management of recurrent genuine stress incontinence.

Recurrent stress incontinence is frequently a result of incomplete preoperative evaluation. Evaluation of surgical failures must include an assessment of urethral sphincter function by endoscopy, UCPP, or video-urodynamics. Patients with GSI and a mobile urethovesical junction and normal urethral closure pressure should be corrected by a Burch sling or MMK. Patients with low urethral closure pressure and normal or borderline UVJ mobility should have a suburethral sling procedure. Patients with a nonfunctioning urethral sphincter respond best to an artificial urinary sphincter.

Female↗

PubMed2005

Suburethral slingplasty evaluation study in North Queensland, Australia: the SUSPEND trial.

OBJECTIVE: To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence. METHODS: Following ethics approval, 195 (3 x 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. MAIN OUTCOME MEASURES WERE: (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings. RESULTS: There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11). CONCLUSIONS: All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out.

Aged↗

PubMedDate not supplied

Medium-term follow-up on use of freeze-dried, irradiated donor fascia for sacrocolpopexy and sling procedures.

The aim of this study was to document longer-term follow-up of patients in a previously reported series who underwent either sacrocolpopexy (SCP) or suburethral sling procedures utilizing freeze-dried, irradiated donor fascia. Subjects from the initial series of 67 SCPs and 35 slings were included in this retrospective chart review of postoperative follow-up where surgical follow-up longer than 3 months from the procedure was available. Subjects undergoing SCP were examined at the time of any clinical visit and their pelvic organ support evaluated utilizing the POP-Q system. The SCP procedure was considered to be unsuccessful if any anterior vaginal wall point (Aa or Ba) was at the hymen or beyond, or if the vaginal apical point (C or D) descended to a point at least halfway to the hymen from a position of perfect apical support. Subjects who did not return for clinical examination after their 3-month postoperative visit but who had been in telephone contact with the clinic stating that they had experienced symptomatic recurrence of their POP were also included as having unsuccessful SCP procedures. Those similarly in contact with the office by telephone, but not clinically examined, who indicated no subjective return of their POP, were coded as successful. The outcome of the sling procedure was primarily evaluated subjectively, with the patient indicating that stress incontinence symptoms were present or absent. Follow-up was available for 75 patients, who had undergone 54 SCP and 27 sling procedures (6 patients had undergone both SCP and sling procedures). When failure was defined according to any of the criteria listed in the methods section, 45 (83%) patients experienced SCP failure at a median of 12 months after surgery. A total of 14 (52%) sling procedures were failures, with recurrent SUI symptoms experienced from 2 weeks to 24 months (median 3 months) after the procedure. One year after surgery, 23 (43%) SCPs were known to be failures, and 11 (41%) slings were known to be failures. The remaining 13 (48%) slings were subjectively successful when last seen 7-51 months after surgery. We reoperated on 21 (40%) patients. At the time of repeat SCP (chosen by 16 patients) we found graft between the sacrum and vagina in just 3 patients (19%). The use of freeze-dried, irradiated donor fascia for both SCP and sling procedures was associated with an unacceptably high failure rate in our series.

Aged↗

PubMed1999

Erosion of a fascial sling into the urethra.

When synthetic materials are used for the construction of pubovaginal slings, urethral erosions may occur. This complication has not been reported with fascial slings. We present a case of a 34-year-old woman who underwent a pubovaginal sling procedure using rectus fascia. After 10 weeks of urinary retention, urethroscopy identified an erosion of the sling at the midurethra. Surgical revision restored normal voiding without recurrent stress incontinence. Although urethral erosions have been reported with synthetic suburethral slings, this case suggests that erosions can also occur with fascial slings. Careful positioning and minimal tension on the sling arms may minimize this risk.

Adult↗

PubMedDate not supplied

Voiding function after a modified no-tension pubovaginal sling.

Voiding dysfunction following sling procedures for correction of genuine stress urinary incontinence (GSI) is a frequently reported complication. This study sought to determine if voiding dysfunction could be reduced by eliminating sling tension against the urethra. Participants were diagnosed with GSI and randomized to one of two surgical groups. One received a conventional suburethral sling and the other received a modified sling placed at the mid-urethra without tension. Voiding trials after surgery monitored for voiding dysfunction. Multichannel urodynamic studies were performed pre- and post-operatively. Cure rates for GSI were similar for the two groups (91.7 vs. 88.5%). The 27 patients in the modified group voided an average of 5 days earlier than the 21 patients in the conventional group. Conventional group patients were more likely to have urinary retention (125 vs. 49 cc, p=0.03). The modified group had a lesser change in average closure pressure following surgery. Results suggested a higher increase in urethral resistance in the conventional group (0.72 vs. 1.88 cm H2O ml(-2) sec2). No differences were seen in symptomatic urinary urgency or urge incontinence following surgery. This study demonstrated a no-tension sling at the mid-urethra to afford equivalent cure of GSI with significant reduction of voiding dysfunction.

Adult↗

PubMed2001

Complications and initial continence rates after a repeat pubovaginal sling procedure for recurrent stress urinary incontinence.

PURPOSE: We evaluated the safety and efficacy of repeat pubovaginal sling procedures for recurrent stress urinary incontinence. MATERIALS AND METHODS: We retrospectively reviewed the records of 14 patients in whom an initial suburethral sling procedure failed, who then underwent a repeat pubovaginal sling procedure for recurrent stress urinary incontinence at our institution and who were available for followup evaluation. Mean followup after re-operation was 17 months (range 5 to 41). The response to surgery was assessed using the Blaivas-Groutz anti-incontinence surgery response score. RESULTS: There were no intraoperative complications. Mean blood loss was 155 cc (range 50 to 750) and average operative time was 101 minutes (range 80 to 145). Long-term urinary retention developed in 1 of the 14 patients (7%). There were no deaths. Two patients (14%) had postoperative complications, including a pelvic abscess and osteomyelitis pubis in 1 each. Based on the Blaivas-Groutz anti-incontinence scale 7 of the 14 patients (50%) were cured, 1 (7%) had a good response, 4 (29%) had a fair response, 2 (14%) had a poor response and none had treatment failure. Subjectively 12 of the 14 women (86%) considered themselves cured or improved and 2 (14%) considered the operation to have failed. CONCLUSIONS: Our data imply that a repeat pubovaginal sling procedure after an initial failed operation is associated with low complication and acceptable continence rates. It should be considered a reasonable treatment option in select women with recurrent stress urinary incontinence.

Aged↗

PubMed2005

[Urinary complications in sub-urethral sling procedures].

INTRODUCTION: Urinary complications following sub urethral sling procedures are common, and management of these complications continue to be discussed. METHODS: The literature available on Medline/PubMed, relating to urinary complications associated with suburethral sling procedures, was reviewed. RESULTS: Bladder perforation, which occurs with an incidence of 5.7% in tension-free vaginal tape procedure, requires repositioning of the sling, but does not cause any increase in postoperative morbidity. The trans-obturator approach appears to decrease this risk. Urethral perforation, which is uncommon (0.4-1%), is a contraindication to maintenance of the sling. Bladder erosion is rare, requiring resection of the mesh with a combined abdominal and cystoscopic approach. Urethral mesh erosion (0.07% to 1.5%) also requires surgical sling removal, but few patients remain continent because this removal requires a large urethrolysis (recurrence rate of incontinence is 66% following removal of the sling). Bladder outlet obstruction occurs frequently after sub-urethral procedures. When complete obstruction is clinically evident 2 days after a sub-urethral sling procedure, immediate reintervention is performed with a rapid return to normal voiding. Recurrence rate of stress incontinence is less than 30% following reintervention.

Equipment Failure↗

PubMed2004

Tension-free vaginal tape, Burch, and slings: are there predictors for early postoperative voiding dysfunction?

This study compared the incidence, duration, and predictors of early postoperative voiding dysfunction (VD) after three continence operations. Charts of women undergoing tension-free vaginal tape (TVT), Burch, or suburethral sling were reviewed. Early postoperative VD was defined as urinary retention or postvoid residual (PVR) >200 ml at discharge. Analysis of variance, Chi-square, and non-parametric tests were used. Sixty-three TVT, 42 Burch and 33 slings were identified. Incidence of VD with TVT, sling, and Burch was 50, 24, and 15%, respectively ( P<0.001), and the mean number of days of postoperative catheter use was 9, 21, and 5 days, respectively ( P=0.04). Patients with VD, compared with those with normal voiding, had smaller preoperative PVR (50 vs. 75 ml, P=0.005), longer catheterization (29 vs. 3 days, P<0.001), and more urinary tract infections (43 vs. 15%, P<0.001). Early postoperative VD is an underreported but frequent postoperative complication which is difficult to predict.

Aged↗

PubMed1997

Gore-Tex sling urethral suspension in type III female urinary incontinence: clinical results and urodynamic changes.

The authors prospectively evaluated 24 consecutive female patients with type III stress urinary incontinence, ranging in age from 36 to 70 years (mean 55 years). All patients were operated upon and had a vesicourethral suspension by a Gore-Tex suburethral sling. All were evaluated urodynamically 6 and 30 months after surgery. In this group of patients clinical cure of incontinence was observed in 83.3% (20) and in the remaining 4 patients it was significantly improved. In 2 patients there was an erosion of the urethra and the sling had to be removed 3.5 years later. Five other women remained dry but complained of occasional irritative symptoms, and several urinary tract infections were recorded (2-3 per year), which were documented by positive urine cultures. In the remaining 17 patients no erosion was observed and no irritative symptoms were reported. The urodynamic evaluation revealed an excellent postoperative result both 6 months and 30 months after surgery.

Adult↗

PubMed1995

Modified pubovaginal sling and Martius graft for repair of the recurrent vesicovaginal fistula involving the internal urinary sphincter.

A modified Martius graft interposition flap was used in conjunction with the modified pubovaginal sling bladder suspension to treat a recurrent vesicovaginal fistula involving the proximal urethra and bladder neck. The patient recovered with no incontinence, voiding dysfunction or dyspareunia. Incontinence should be anticipated with vesicovaginal fistulas involving the internal sphincter and repair should be tailored to include an organic suburethral sling.

Adult↗