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Assessing outcome after a modified vaginal wall sling for stress incontinence with intrinsic sphincter deficiency

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Abstract

Forty women with stress incontinence, intrinsic sphincter deficiency (ISD), associated or not with urethral hypermobility, a Valsalva leak point pressure (VLLP) <60 cmH20 and a maximum urethral closure pressure <30 cmH20 underwent in situ vaginal wall sling. The main modification to the technique was the use of two small Marlex meshes placed at the lateral edges of the sling. Outcome was assessed by pad use, surgical results and patients’ satisfaction. Data of 39/40 patients were analyzed after a minimum follow-up of 1 year. After surgery 30/39 patients were completely dry (no pads), stress incontinence disappeared in 22/39, and 30/39 patients were satisfied with outcome. Reasons for dissatisfaction included recurrence of stress incontinence in three, infections in one and urge incontinence in five. Overall results are good given this category of patients. The vaginal wall sling can be recommended for patients with ISD because the results are promising, it corrects urethral hypermobility and, in our experience, it does not cause obstruction if correctly performed.

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Acknowledgements

The authors thank Dr. G. Boyd for the translation of the paper.

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Authors and Affiliations

  1. Department of Urology, University of Perugia, Via Brunamonti 51, 06100 , Perugia, Italy

    Elisabetta Costantini, Luigi Mearini, Ettore Mearini, Cinzia Pajoncini, Federico Guercini & Massimo Porena

  2. Paediatrics and Gynaecology Department, University of Perugia, Perugia, Italy

    Vittorio Bini

Authors
  1. Elisabetta Costantini
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  2. Luigi Mearini
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  3. Ettore Mearini
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  4. Cinzia Pajoncini
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  5. Federico Guercini
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  6. Vittorio Bini
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  7. Massimo Porena
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Correspondence to Elisabetta Costantini.

Additional information

Editorial Comment: The authors present a method for a modified vaginal wall sling for the treatment of urinary incontinence. The main modification to previous techniques was the use of two small Marlex meshes placed on the lateral edges of the in situ vaginal wall sling. Although the authors present acceptable cure rates with the procedure, they present a 29% incidence of post-operative urge or mixed urinary incontinence. The authors compared this procedure with allograft and autograft sling material, but do not compare it with synthetic material. They give no convincing argument that this procedure is superior to other modified sling procedures such as the TVT, which can be performed with comparable results and less morbidity.

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Costantini, E., Mearini, L., Mearini, E. et al. Assessing outcome after a modified vaginal wall sling for stress incontinence with intrinsic sphincter deficiency. Int Urogynecol J 16, 138–146 (2005). https://doi.org/10.1007/s00192-004-1173-5

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  • DOI: https://doi.org/10.1007/s00192-004-1173-5

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