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PubMed2000

[Materials used in treatment of stress urinary incontinence with suburethral sling].

Suburethral sling is a classical method of surgical repair of female stress urinary incontinence (SUI). Initially reserved for SUI due to sphincter incompetence, this method now appears to be indicated for other types of SUI. A large number of organic and synthetic materials have been used in published series. The long-term functional results reported in the literature vary between 65 and 98%, regardless of the materials used. Some of the complications observed are specific to the type of material. Synthetic slings appear to be associated with a higher complication rate. It is too early, based on data of the literature, to determine the real role of Prolene tape (TVT).

Biocompatible Materials↗

PubMed2000

Suburethral sling operations for urinary incontinence in women.

BACKGROUND: Suburethral slings are surgical operations used to treat women with urinary incontinence. They were originally designed for recurrent stress incontinence, but have also been used recently for primary cases. OBJECTIVES: To determine the effects of suburethral slings on stress or mixed urinary incontinence in comparison with other management options. SEARCH STRATEGY: We searched the Cochrane Incontinence Group's trials register, The National Research Register and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 1999, inclusive. Date of most recent search: January 2000. SELECTION CRITERIA: Randomised or quasi-randomised trials that included suburethral slings for the treatment of urinary incontinence. DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data. MAIN RESULTS: Five trials were identified including 206 women - 126 treated with suburethral slings and 80 with other procedures. Three compared suburethral slings with open abdominal retropubic suspensions (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In the fifth trial, different types of suburethral sling were compared with each other. Six types of slings were included (Teflon, polytetrafluoroethylene, Goretex, porcine dermis, lyophilized dura mater and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections, artificial sphincters or conservative management. There is one ongoing trial with Tension-free Vaginal Tape (TVT) versus Burch colposuspension, results expected in August 2000. For each outcome data were available only from individual trials. There were no detectable differences in terms of voiding dysfunction, urge incontinence or detrusor instability between suburethral slings and abdominal or needle suspensions, but the data were few and the confidence intervals wide. More peri-operative complications were reported after suburethral slings than after needle suspension (9/10 vs 2/10; RR 4.5, 95% CI 1.3 to 15.8), and length of stay was longer after sling operations than after abdominal or needle suspension. In the trial which compared autologous (rectus fascia) with synthetic (Goretex) slings, 11/32 vs 2/16 women had not improved after a year (RR 2.75, 95% CI 0.69 to 10.95), but fewer had complications (0/32 vs 5/16; RR 0.05, 95% CI 0 to 0.8). Two women in the second group had late sling erosion of the urethra requiring removal of the Goretex, although their incontinence remained cured. REVIEWER'S CONCLUSIONS: There were few data available to compare suburethral sling operations with other surgical management (abdominal and needle suspension, or different types of slings). In general, the quality of trials was poor with no clear method of randomisation, small numbers of women studied, short follow-up and scanty information on outcome measures. There is not enough evidence on which to judge whether suburethral slings are better or worse than other surgical or non surgical managements.

Female↗

PubMed2005

Two-dimensional and three-dimensional ultrasound imaging of suburethral slings.

OBJECTIVE: Suburethral slings have become the most commonly performed anti-incontinence procedures in many developed countries. Three types of implant account for the majority of such surgery in Australia: tensionless vaginal tape (TVT), suprapubic arc procedure (SPARC) and intravaginal slingplasty (IVS). The aim of this study was to determine differences in position and mobility of these implants, and to determine whether such differences explain variations in clinical outcome. METHODS: In a prospective randomized controlled trial, 195 women were randomized to TVT (n = 67), IVS (n = 64) or SPARC (n = 64). Thirteen women were excluded from the study due to incomplete preoperative data. Of the remaining 182 women, 146 (50 TVT, 48 IVS, 48 SPARC) were seen between 2 and 23 months after their procedure (80%). After an interview, two-dimensional (2D) and three-dimensional (3D) pelvic floor ultrasound was performed. 3D-volume analysis was carried out on a computer with the help of proprietary software (GE Kretz 4D View). Assessors of ultrasound data were blinded against group allocation. RESULTS: There were no significant differences in subjective cure/improvement of stress or urge incontinence or overall subjective cure/improvement. Symptoms, including those of voiding dysfunction, did not vary between groups. All tapes could be imaged by ultrasound. TVT and SPARC were highly echogenic, with the SPARC generally flatter and of wider weave. The IVS seemed narrower and less echogenic. Tape position and mobility were similar, with a trend towards greater distances between tape and symphysis pubis and greater horizontal tape mobility in the SPARC group. CONCLUSIONS: The three types of suburethral sling, namely TVT, SPARC and IVS, investigated using 2D and 3D ultrasound, have comparable short-term clinical and anatomical outcomes.

Female↗

PubMed2005

[Comparison of diferents suburethral slings for the treatment of stress urinary incontinence].

OBJECTIVES: To compare the results of the different procedures of sling suburetral used in our service (TVT, Sparc, IVS, Obtape and Monarc) for the treatment of the female urinary incontinence. MATERIAL AND METHODS: 96 patients retrospective analysis affects of female urinary incontinence and subjected to different procedures of sling suburethral without tension. The half age: 56.1 +/- 10.7 years. 75 patients were intervened by means of procedures retropubics (48 TVT, 17 Sparc, 10 IVS) and 21 with obturators (10 Obtape, 11 Monarc). The half time of pursuit: 26.3 +/- 12.7 months (29.4 months for the methods retropubics and 11.7 for the obturators). The analyzed variables were: age, obesity, grade of previous incontinence, type of used procedure, time of pursuit, and previous surgical procedures. We compare the complications and the results obtained with the different ones technical. RESULTS: the cure percentage was of 95.7%. 7 patients presented complications: one intestinal perforation, two bladders perforations, one erosion of vaginal wall, three incontinences of novo urgency. In 6 cases the stress incontinence persists. When analyzing the association between the diverse variables and the success, we appreciate that the variables with value presage were the age and the obesity (P < 0.05) not observing relationship with the technique employeed. CONCLUSIONS: The existence of multiple surgical approachs and a varied auxiliary materials allow each surgeon to choose that with the one that is more familiarized and comfortable without, seemingly, influence it in the results.

Adult↗

PubMed1995

Suburethral sling release.

BACKGROUND: The suburethral sling is an effective surgical procedure for curing genuine stress incontinence. However, a well-known complication is urinary retention. This report describes a method of modifying sling placement 6 weeks after the initial surgery to ameliorate the complication of urinary retention. CASE: A 68-year-old woman had undergone suburethral sling placement as part of her pelvic reconstructive surgery. Preoperatively, she had objective, urodynamic evidence of severe genuine stress incontinence, consistent with intrinsic sphincter deficiency. She was unable to void for 6 weeks postoperatively, at which time this procedure was offered. After an uneventful suburethral sling release, the patient had immediate return of voiding function, and symptoms resolved over the next 2 weeks. CONCLUSION: This procedure may be a useful alternative to sling removal in cases of persistent urinary retention after placement of a suburethral sling.

Aged↗

PubMed2005

Traditional suburethral sling operations for urinary incontinence in women.

BACKGROUND: Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence. OBJECTIVES: To determine the effects of traditional suburethral slings on stress incontinence alone or stress with other types of urinary (mixed) incontinence in comparison with other management options. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 22 December 2004), The UK National Research Register (Issue 1, 2001) and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 2003, inclusive. SELECTION CRITERIA: Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence. DATA COLLECTION AND ANALYSIS: All three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data. MAIN RESULTS: Thirteen trials were identified including 760 women of whom 627 were treated with suburethral slings. Five compared suburethral slings with open abdominal retropubic colposuspension (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In six trials, different types of suburethral sling were compared with each other. Nine types of slings were included (Teflon, polytetrafluoroethylene, prolene used for transvaginal tape (TVT), porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections or artificial sphincters. One trial compared surgery (including slings) with anticholinergic medication.There were no statistically significant differences between traditional slings and other types of continence surgery, or between one type of traditional sling and another sling. Confidence intervals around the estimates were wide, reflecting the few data available, and so clinically important differences could not be ruled out. AUTHORS' CONCLUSIONS: The data on sub urethral sling operations remain too few to address the effects of this type of surgical treatment. Few trials are reported by authors in a complete fashion and most information came from abstracts presented in annual meetings. The broader effects of suburethral slings could not be established since trials did not include appropriate outcome measures such as general health status, health economics, pad testing, third party analysis and time to return to normal activity level. Data obtained from thirteen trials did not provide reliable estimates because of their sizes, and heterogeneity of designs, populations studied, and types of comparisons made. Reliable evidence on which to judge whether or not suburethral slings are better or worse than other surgical or conservative management is currently not available.

Female↗

PubMed2005

A tissue-engineered suburethral sling in an animal model of stress urinary incontinence.

OBJECTIVE: To create and evaluate the functional effects of a tissue-engineered sling in an animal model of stress urinary incontinence (SUI). MATERIALS AND METHODS: Twenty female Sprague-Dawley rats were divided into four equal groups: a control group (C) had no intervention before the leak-point pressure (LPP) was measured; a denervated group (D) had bilateral proximal sciatic nerve transection (PSNT) and periurethral dissection with no sling placed; group S had concomitant bilateral PSNT and a suburethral sling of small intestinal submucosa (SIS) placed; and group (M) had concomitant bilateral PSNT with implantation of a tissue-engineered sling. The suburethral sling was placed via a transabdominal approach with the sling sutured to the pubic bone. Tissue-engineered slings were prepared with muscle-derived cells obtained via the pre-plate technique and subsequently seeded for 2 weeks on a SIS scaffold. Suburethral slings were implanted 2 weeks before LPP testing, using the vertical-tilt method. RESULTS: Surgically placing a suburethral sling is feasible in the female rat, with few complications. LPPs from both sling groups (S and M) were not significantly different from untreated controls (C). The S, M and C groups all had significantly higher LPPs than group D. Importantly, no rat from either sling group (S and M) had signs of urinary retention. CONCLUSIONS: Placing tissue-engineered slings in an animal model of SUI resulted in LPP values that were not significantly different from those in untreated control or SIS (S) groups. These data show that incorporating muscle stem cells into SIS slings does not adversely alter the advantageous mechanical properties of the SIS sling in a model of SUI, and provide the basis for future functional studies of tissue-engineered sling materials with long-term retention.

Animals↗

PubMed1997

Sling incision with associated vaginal wall interposition for obstructed voiding secondary to suburethral sling procedure.

Obstructed voiding is a well recognized complication following a suburethral sling procedure. Current methods of transvaginal and transabdominal urethrolysis have had variable success rates in relieving the obstruction, and do not restabilize the urethra to prevent potential postoperative stress incontinence. We report on a procedure used in 4 cases which addresses both of these issues. All patients had persistent urinary retention beyond 8 weeks after a suburethral sling procedure. An oupatient procedure consisting of sling incision and associated tissue interposition (vaginal wall in three cases and fascia lata in one) was successful in relieving the obstruction. Continence status was maintained in 3 of the 4 patients. There were no major complications of this outpatient procedure.

Aged↗

PubMed2002

Vaginal erosion of cadaveric fascia lata following abdominal sacrocolpopexy and suburethral sling urethropexy.

The aim of this paper is to report vaginal erosion of cadaveric fascia lata used for abdominal sacrocolpopexy and suburethral sling urethropexy. The charts of patients who underwent abdominal sacrocolpopexy or suburethral sling urethropexy between March 1994 and February 1999 were reviewed for perioperative data. In 47 cases of abdominal sacrocolpopexy or suburethral sling, 32 utilized cadaveric fascia lata, with 11 for sacrocolpopexy and 22 for suburethral sling. Vaginal erosion of cadaveric fascia lata graft was noted in 5 (23%) following sling procedure and 3 (27%) following sacrocolpopexy, diagnosed a mean of 36.8 days (+/- 7.1, range 27-45) following surgery. These women were treated conservatively with estrogen vaginal cream, and both vaginal and oral antibiotics. Four of the 8 (50%) underwent excision of the exposed graft and reapproximation of the vaginal edges under local anesthesia, whereas the remainder responded to medical therapy alone. None of the patients experienced recurrence of vaginal vault prolapse or urinary incontinence following graft erosion. Comparison of women with vaginal erosion of cadaveric fascia lata to those without revealed an association with perioperative febrile morbidity (P=0.04), but not with age, hormonal or insurance status, body mass index, history of diabetes mellitus or smoking, length of surgery, estimated blood loss, change in hematocrit, or other perioperative complications. Vaginal erosion of cadaveric fascia lata utilized for abdominal sacrocolpopexy and suburethral sling was noted in 25% of our patients and may have an infectious etiology. Conservative treatment with antibiotics and estrogen is effective, but removal of exposed graft with vaginal closure may be necessary.

Cadaver↗

PubMed2003

Laparoscopic suburethral sling procedure.

STUDY OBJECTIVE: To describe the technique of laparoscopic suburethral sling and discuss patient satisfaction and subjective continence rates over 7 years. DESIGN: Retrospective analysis (Canadian Task Force classification III). SETTING: Private practice. PATIENTS: Sixty-three consecutive patients. INTERVENTION: Laparoscopic sling procedure using either autologous or donor fascia. MEASUREMENTS AND MAIN RESULTS: The space of Retzius is entered laparoscopically. Then from a vaginal approach, a small midline vertical incision is made below the urethra, and vaginal epithelium is dissected off underlying periurethral and paravesical fascia. Material for the sling is passed underneath the urethra and secured laparoscopically to Cooper's ligaments bilaterally. Over 7 years, 63 laparoscopic suburethral sling procedures were performed. Overall, patients reported 88.9% satisfaction rate and 81.0% subjective continence rate. CONCLUSION: The laparoscopic approach is an acceptable alternative to other suburethral sling procedures.

Aged↗

PubMed1993

Tissue reaction to expanded polytetrafluoroethylene suburethral sling for urinary incontinence: clinical and histologic study.

OBJECTIVE: The use of expanded polytetrafluoroethylene suburethral sling for recurrent urinary incontinence has shown an excellent cure rate but a number of complications. This study was designed to evaluate patients who had tissue reaction or removal of the sling, to determine potential causes, clinical course, and eventual outcome. STUDY DESIGN: A retrospective review of consecutive charts was completed for 115 patients who had suburethral sling surgery with expanded polytetrafluoroethylene. Patients having tissue reaction or removal of sling material were identified, and eight removed sling specimens were analyzed histologically with Milligan's trichrome, hematoxylin and eosin, fibrin, Brown-Brenn bacteria, and Dahl's calcium stains. RESULTS: Twenty-four patients had reactions to the sling material, and 23 slings were eventually removed. Seventeen of 23 patients having sling removal remained continent. Histologic evaluations revealed gram-positive cocci in all expanded polytetrafluoroethylene patch interstices. Fibrous tissue, fibroblasts, and collagen were present in one half of specimens. CONCLUSION: There is a 23% reaction or removal rate for expanded polytetrafluoroethylene suburethral sling procedures. Seventeen of 23 patients remained continent in spite of sling removal. Histologic studies showed gram-positive cocci in the patch interstices, although prophylactic antibiotic coverage did not prevent infection and cultures from the vaginal or abdominal reaction sites did not reveal a significant growth of organisms. Patients need to be aware of the high complication rate for this suburethral sling procedure, and physicians need to work further to modify sling materials and techniques to reduce complications.

Abdomen↗

PubMed1996

Banked human fascia lata for the suburethral sling procedure: a preliminary report.

OBJECTIVE: To report our initial experience with allogenic (human cadaver donor) fascia lata for the suburethral sling procedure. METHODS: Allogenic fascia lata for the suburethral sling procedure has been used in our practice since July 1994. Fascial grafts were obtained from licensed tissue banks. Women who underwent this procedure were followed prospectively to determine the incidence of perioperative complications, the incidence of local wound complications at the sling insertion site, and the subjective and objective cure rates. RESULTS: Sixteen women underwent the suburethral sling procedure with allogenic fascia. Fourteen had genuine stress urinary incontinence and two required replacement of a previously placed synthetic graft because of chronic infection. Follow-up ranged from 6 months to 1 year. No patient developed sinus tract formation or persistent granulation tissue. Two of 16 patients (12%) developed abdominal wound infections, which resolved with local care. The mean duration of postoperative bladder drainage was 29 days. One patient continued to require intermittent catheterization at 187 days. Among the 14 women with preoperative genuine stress incontinence, the subjective cure rate was 86% and the objective cure rate was 79%. The two patients who required replacement of a chronically infected synthetic graft remained subjectively continent. CONCLUSIONS: These preliminary data suggest that allogenic fascia lata is an acceptable material for the suburethral sling procedure. This material may be considered as an alternative to autologous fascia, which must be harvested from the patient intraoperatively, and to synthetic materials, which have been associated with local complications in up to 40% of cases.

Aged↗

PubMed1995

Long-term clinical and urodynamic evaluation of the polytetrafluoroethylene suburethral sling for treatment of genuine stress incontinence.

OBJECTIVE: To assess long-term clinical and urodynamic outcomes of suburethral sling procedures using polytetrafluoroethylene grafts. METHODS: Between January 1986 and May 1991, 108 women underwent suburethral sling placement to treat genuine stress incontinence. At least 1 year after surgery, 62 women participated in a telephone interview about surgical outcome and completed a follow-up urodynamic evaluation. RESULTS: Seventy-three percent of patients reported stress incontinence cure and 61% were objectively cured. Neither low urethral closure pressure nor a history of multiple prior anti-incontinence procedures, singly or in combination, adversely affected outcome. Postoperative maximum urethral closure pressure and functional urethral length were significantly greater in patients who were cured of their incontinence than in those whose surgery failed. Patients who were cured had higher amplitude detrusor contractions during micturition and greater post-void residual urine than those who were not cured. Thirty-three percent of patients with urodynamically stable bladders preoperatively developed detrusor instability after surgery. Detrusor instability remitted after surgery in half of the patients who had this condition preoperatively. Postoperative wound complications developed in 40% of patients who underwent sling placement, and 22% of the grafts were eventually removed. CONCLUSION: Polytetrafluoroethylene suburethral sling placement is an effective treatment for stress incontinence and low urethral pressure. Urodynamic data suggest that urethral obstruction is responsible for surgical cure. Patients should be warned of the high complication rate for this suburethral sling procedure and that graft removal may be necessary.

Adult↗

PubMed1998

Effect of preoperative voiding mechanism on success rate of autologous rectus fascia suburethral sling procedure.

OBJECTIVE: To evaluate the efficacy of the rectus fascia suburethral sling procedure and to determine whether preoperative voiding caused by the Valsalva maneuver is a risk factor for short-term objective failure. METHODS: This study is a retrospective chart review of 50 patients who underwent the suburethral sling procedure with rectus fascia at our institution between March 1994 and August 1996. All patients had genuine stress incontinence with intrinsic sphincteric deficiency or urethral hypomobility. Preoperative multichannel urodynamics were measured in all patients, and postoperative urodynamic testing was done at 3 months in 48 patients. RESULTS: Ninety-four percent of patients were cured subjectively of stress urinary incontinence at 3 months. Objective cure was found by urodynamic measurements in 73% of the 48 patients who underwent postoperative testing. There was an increased risk of objective failure in patients whose voiding preoperatively was caused by the Valsalva maneuver. Objective failure was found at 3 months in 54% of the 13 patients in the Valsalva group, compared with 17% of the 35 in the non-Valsalva group (P=.011). Patients in the Valsalva group also tended to have longer durations of postoperative catheterization than did patients in the non-Valsalva group (P=.049). CONCLUSION: The rectus fascia suburethral sling procedure appears to be an effective operation for the treatment of genuine stress incontinence in carefully selected patients. However, patients who are identified preoperatively as voiding because of the Valsalva maneuver have a higher failure rate for this procedure.

Adult↗

PubMed2001

Protective effect of suburethral slings on postoperative cystocele recurrence after reconstructive pelvic operation.

OBJECTIVE: The purpose of this study was to evaluate the independent effect of suburethral sling placement on the risk of cystocele recurrence after pelvic reconstructive operation. STUDY DESIGN: One hundred forty-eight women with cystoceles to or beyond the hymenal ring underwent pelvic reconstructive operation, with or without incontinence procedures, and were evaluated at 12 and 52 weeks after operation with a standardized pelvic examination. Rates of recurrent prolapse, at all sites, were statistically compared between subjects with and without suburethral slings. A multiple regression analysis was used to determine the independent effect of sling placement on the risk of recurrent cystoceles. RESULTS: Suburethral sling placement was associated with a 54.8% reduction in the mean rate of postoperative cystocele recurrence (P =.004). This protective effect was observed as early as 12 weeks and remained significant at 1-year follow up (42% vs 19%). A markedly reduced risk of cystocele recurrence was observed when women with sling procedures were compared with all other women, with those women who underwent other incontinence operations, and even with those women who had undergone prolapse repair with no incontinence procedure. The protective effect of the sling procedure remained highly significant (odds ratio, 0.29; P =.0003), even after controlling for potentially confounding variables in a multiple logistic regression model. CONCLUSION: Suburethral sling procedures appear to significantly reduce the risk of cystocele recurrence after pelvic reconstructive operation, in contrast with the effect of retropubic urethropexy and needle suspensions. These findings should be considered when the surgical treatment of stress incontinence that accompanies pelvic organ prolapse is being planned.

Adult↗

PubMed1994

Surgical treatment of urinary stress incontinence by a suburethral sling procedure using a Mersilene mesh graft.

A suburethral sling procedure using a Mersilene mesh has been performed in 24 patients. Six patients had recurrent incontinence after an unsuccessful past operation. A postoperative follow-up was done for an average of 24 months. Twenty-three patients were free of symptoms, while only 1 patient had recurrent incontinence. The suburethral sling procedure can be applied to all patients, particularly for recurrent stress urinary incontinence, with reasonable cure rates when performed with a proper technique.

Adult↗

PubMed1996

Postoperative catheterization, urinary retention, and permanent voiding dysfunction after polytetrafluroethylene suburethral sling placement.

OBJECTIVE: To determine the incidence of permanent voiding dysfunction after polytetrafluoroethylene suburethral sling placement, and to assess the effect of voiding mechanism and uroflowmetry on the duration of postoperative catheterization. METHODS: Between January 1986 and April 1991, 108 patients underwent suburethral sling procedures to treat genuine stress incontinence. Medical records were reviewed to collect urodynamic and catheterization data. One year or longer after surgery, 98 women completed a telephone interview evaluating incontinence, self-catheterization, and voiding symptoms. RESULTS: The mean duration of postoperative cathtrerization was 10.7 weeks. There was no significant relationship between preoperative uroflow indices and the duration of catheterization. The presence of a preoperative detrusor contraction was associated with a shorter mean duration of postoperative catheterization (6.1 versus 14.8 weeks, P = .07) and a lower risk of sling removal for retention (7 versus 33%, P = .04). Eight patients continued self-catheterization. Fourteen patients reported other micturition problems: three used the Credé maneuver or double voided to facilitate emptying and 11 were unable to urinate when seated upright. There was no correlation between the duration of catheterization and ongoing voiding dysfunction. Among nine women who underwent further surgery to treat postoperative urinary retention, three continue to catheterize, one performs Credé, and one urinates standing. CONCLUSIONS: Polytetrafluoroethylene suburethral sling placement commonly produces permanent voiding difficulty. Patients who void without a detrusor contraction are at increased risk for prolonged postoperative catheterization. Sling removal does not ensure resolution of urinary retention and may be no better than leaving the sling in place.

Adult↗

PubMed2005

Suburethral sling materials: best outcome with autologous tissue.

OBJECTIVE: This study was undertaken to assess the outcome of suburethral slings by type of sling material. STUDY DESIGN: A retrospective review of women who underwent a suburethral sling between January 1997 and January 2003 with autograft, allograft or xenograft materials. Objective failure was defined as urinary leakage with cough stress testing at any time after 3 months, postoperatively. Objective cure was defined as no leakage with a standing cough stress test with at least 200 mL bladder volume at a minimum of 12 months postoperatively. Data were analyzed using Student t, Wilcoxon rank sum, and Kaplan-Meier survival tests. RESULTS: A total of 241 women were included in this study: 78 received autograft, 80 received allograft, and 83 received xenograft. Objective failure was 36% and 46% for allograft and xenograft, respectively compared with 13% for autograft (P < .001). CONCLUSION: Autograft has a significantly higher cure rate when used for suburethral slings.

Adult↗