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NEUROLOGY
& FEMALE UROLOGY
Salvage
spiral sling techniques: alternatives to manage disabling recurrent urinary
incontinence in females
Rodriguez AR, Hakky T, Hoffman M, Ordorica R, Lockhart J
Department of Urology, University of South Florida and Tampa General Hospital,
Tampa, Florida, USA
J Urol. 2010; 184: 2429-33
- Purpose:
Females with recurrent stress urinary incontinence after anti-incontinence
surgery represent a therapeutic challenge. In our experience and that
of others standard sling procedures have occasionally failed to correct
these problems. We determined the effectiveness of various spiral sling
techniques used in these cases to manage pipe stem urethras in which
conventional slings had failed.
Materials And Methods: Between January 2007 and July 2008 we evaluated
30 female patients with persistent stress urinary incontinence after
multiple failed anti-incontinence procedures. Preoperative and postoperative
evaluation consisted of history, physical examination, number of pads,
Stamey score and quality of life questionnaires.
Results: We followed 28 patients a minimum of 15 months (range 15 to
18). Mean patient age was 60 years (range 36 to 84). At presentation
patients had undergone a mean of 3.5 prior vaginal procedures (range
1 to 6) and used a mean of 7 pads daily (range 3 to 12). Of the patients
21 received a synthetic spiral sling, 5 received an autologous spiral
sling (rectus fascia in 3 and fascia lata in 2) and 3 received a lateral
spiral sling. Mean pad use decreased to 0.9 daily (range 0 to 2, p<0.05).
Postoperative mean Stamey score decreased from 2.6 to 0.3 (p<0.05).
Complications included unilateral vesical perforation in 3 patients
with a contralateral lateral spiral sling. The overall success rate
was 72%.
Conclusions: Salvage spiral sling techniques are a satisfactory alternative
treatment for refractory stress urinary incontinence. When synthetic
material cannot be used, autologous tissue can provide similar results.
When the bladder is perforated unilaterally, a lateral spiral sling
can be used on the contralateral side.
- Editorial
Comment
This paper discusses the use of a salvage spiral urethral sling in a
very difficult to treat patient population, that is, females who have
failed multiple vaginal operations for urinary incontinence. The authors
provide an excellent technical analysis and state that when using this
technique they are able to salvage approximately three out of four.
Of interest is that they describe the use of both autologous fascia
as well as synthetic graft. Operative tactics are described in the event
of a bladder injury at the time of dissection (laterally placed spiral
sling); this is very valuable in view of the potential for injury during
the periurethral dissection in this patient population with a history
of multiple surgeries. In addition, the authors discuss the use of this
operation as opposed to the use of artificial urinary sphincter. Given
the success rate of this operation mirrors that reported for artificial
urinary sphincter in female patients, it has a potential to achieve
a great deal of popularity in this very difficult to treat population
(1).
Reference
- Thomas
K, Venn SN, Mundy AR: Outcome of the artificial urinary sphincter in
female patients. J Urol. 2002; 167: 1720-2.
Dr.
Steven P. Petrou
Professor of Urology, Associate Dean
Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu
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