International Urogynecology Journal

, Volume 7, Issue 3, pp 133–137 | Cite as

Clinical outcome and changes in connective tissue metabolism after intravaginal slingplasty in stress incontinent women

  • C. Falconer
  • G. Ekman-Ordeberg
  • A. Malmström
  • U. Ulmsten
Original Article


The intravaginal slingplasty procedure (IVS) was carried out on 75 patients with genuine stress urinary incontinence. The main aims of the operation are to create an artificial pubourethral ligament and to tighten the suburethral vaginal wall. An important ingredient in the supportive structures of the genitourinary region is fibrous connective tissue, consisting mainly of collagen. To analyse thi component biopsies were obtained transvaginally, close to the position of the sling, both preoperatively and 2 years after surgery, from 6 patients. Collagen was analysed for concentration and extractability. Extractability by pepsin digestion was increased by 60% 2 years following surgery. Postoperative follow-up studies from 12 months to 3 years showed complete restoration of continence in 63 patients (84%) and considerable improvement in 4 others (5%). The 8 failures (9%) were all related to early rejection of the sling. The IVS procedure is an attractive surgical procedure as it necessitates minimum invasion and can be performed under local anesthesia, with a short hospital stay and sick-leave period. The enhanced collagen extractability indicates a changed metabolism, most likely induced by the implanted sling, resulting in a restoration of the elastic properties of the connective tissue.


Collagen Intravaginal slingplasty Pubourethral ligament Stress urinary incontinence 


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  1. 1.
    Hilton P. Which operation and for which patient? In: Drife JO, Hilton P, Stanton SL (eds.) Micturition. London: Springer Verlag, 1990Google Scholar
  2. 2.
    Abrams P, Blaivas J, Stanton S, Andersen J. The standardization of terminology of lower urinary tract function recommended by the International Continence Society.Int Urogynecol J 1990; 1:45–58Google Scholar
  3. 3.
    DeLancey JOL. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis.Am J Obstet Gynecol 1994;170:1713–1723PubMedGoogle Scholar
  4. 4.
    Versi E, Cardozo L, Brincat M, Cooper D, Montgomery J. Correlation of urethral physiology and skin collagen in postmenopausal women.Br J Obstet Gynaecol 1988;95:147–152PubMedGoogle Scholar
  5. 5.
    Bergman A, Elia G, Cheung D, Perelman N, Nimni M. Biochemical composition of collagen in continent and stress urinary incontinent women.Gynecol Obstet Invest 1994;37:48–51PubMedGoogle Scholar
  6. 6.
    Petros P, Ulmsten U. An integral theory and its method for the diagnosis and management of female urinary incontinence.Scand J Urol Nephrol 1993;Suppl 153:5–52Google Scholar
  7. 7.
    Ulmsten U, Petros P. Intravaginal sling plasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence.Scand J Urol Nephrol 1995;29:75–82PubMedGoogle Scholar
  8. 8.
    Victor A. Pad weighing test—a simple method to quantitate urinary incontinence.Ann Med 1990;22:443–447PubMedGoogle Scholar
  9. 9.
    Ulmsten U, Asmussen M, Lindström K. A new technique for simultaneous urethrocystometry and measurement of urethral pressure profile. Urol Int 1977;32:127–136PubMedGoogle Scholar
  10. 10.
    Uldbjerg N, Ekman G, Malmström A, Olsson K, Ulmsten U. Ripening of the human uterine cervix related to changes in collagen, glycosaminoglycans, and collagenolytic activity.Am J Obstet Gynecol 1983;147:662–666PubMedGoogle Scholar
  11. 11.
    Stegeman H, Stalder K. Determination of hydroxyproline.Clin Chem Acta 1967;18:267–273Google Scholar
  12. 12.
    Yamauchi M, Woodley DT, Mechanic GL. Aging and crosslinking of skin collagen.Biochem Biophys Res Commun 1988; 152:898–903PubMedGoogle Scholar
  13. 13.
    Hayflick L. Theories of biological aging.Exp Geront 1985; 20:145–149Google Scholar
  14. 14.
    Falconer C, Ekman-Ordeberg G, Ulmsten U, Westergren-Thorsson G, Barchan K, Malmström A. Changes in paraurethral connective tissue at menopause or counteracted by estrogen.Maturitas 1996, (in press)Google Scholar
  15. 15.
    Westby M, Asmussen M, Ulmsten U. Location of maximum intraurethral pressure related to urogenital diaphragm in the female subject studied by simultaneous urethrocystometry and voiding urethrocystography.Am J Obstet Gynecol 1982;144:408–412PubMedGoogle Scholar
  16. 16.
    Keane DP, Eckford DE, Abrams P. Surgical treatment and complications of urinary incontinence.Curr Opin Obstet Gynecol 1992;4:559–564PubMedGoogle Scholar
  17. 17.
    Ulmsten U, Henriksson L, Johnsson P, Varhos G. An ambulatory surgical procedure under local anaesthesia for treatment of female urinary incontinence. Int Urogynecol J 1996, (in press)Google Scholar

Copyright information

© International Urogynecology Journal 1996

Authors and Affiliations

  • C. Falconer
    • 1
  • G. Ekman-Ordeberg
    • 2
  • A. Malmström
    • 3
  • U. Ulmsten
    • 4
  1. 1.Department of Obstetrics and GynecologyDanderyd HospitalDanderydSweden
  2. 2.Department of Obstetrics and GynecologyKarolinska HospitalStockholmSweden
  3. 3.Department of Cell and Molecular BiologyLund UniversityLundSweden
  4. 4.Department of Obstetrics and GynecologyUppsala UniversityUppsalaSweden

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