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NEUROLOGY
& FEMALE UROLOGY
doi: 10.1590/S1677-55382010000400027
Requiem
for the suburethral tape
Fletcher SG, Zimmern PE
Female Pelvic Medicine, Reconstructive Surgery and Neurourology, UT South-Western
Medical Center, Dallas, TX, USA
BJU Int. 2010; 105: 445-8
- In this
article, the author discusses the treatment options for women with bothersome
stress urinary incontinence (SUI). He comments on the strong connection
between the urethra and anterior vaginal wall and the complications
related to the synthetic suburethral tapes. Further, the use of a vaginal
wall support procedure with a pubovaginal sling and a mesh in the vaginal
wall to treat UI are discussed.
- Editorial
Comment
An intellectual commentary discussing suburethral tape procedures, the
potential reasons for their success as well as their complications.
The authors note that based on the integral theory, the suburethral
sling will help restore “deficient pubo-urethral ligaments to
their normal anatomy (sic)”. They note that in their personal
experience they have not identified a distinct pubourethral ligament.
This observation has been discussed in previous editorials in this journal
(1) and may explain the ability to maintain urinary continence after
a suprameatal transvaginal urethrolysis (2). In addition, the article
does quote a very candid if not surprising lower level of success with
suburethral sling placement based on their Level 1 evidence.
This review is a worthwhile read for the surgeon interested in expanding
both central and peripheral understanding of sub midurethral sling surgery.
References
- Petrou
SP: Editorial Comment: What are the supportive structures of the female
urethra? Int Braz J Urol. 2006; 32: 249-50.
- Petrou
SP, Brown JA, Blaivas JG: Suprameatal transvaginal urethrolysis. J Urol.
1999; 161: 1268-71.
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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