The Rosti sling: a new, minimally invasive, tension-free technique for the surgical treatment of female urinary incontinence-the first 217 patients

Abstract

Purpose: We evaluated the outcome of a new, innovative, inexpensive tension-free technique, the Rosti sling (RS), for female urinary incontinence.

Materials and methods: RS was performed in 217 patients under local (45%), spinal (52%) or general (3%) anesthesia. A 1.5 x 33 cm strip of polypropylene mesh was inserted under the mid urethra from above through small suprapubic stabs down and out through a 1.5 cm midline vaginal incision using the Stamey needle. Of the women 76% had stress urinary incontinence and 24% had mixed incontinence. Patient age was 24 to 90 years (mean 56) and parity was 0 to 6 (mean 2). The diagnosis of incontinence was based on history and physical examinations with a cough stress test. Mean followup was 23 months.

Results: Mean operative time was 25 minutes (range 15 to 45) and mean hospital stay was 3 days (range 1 to 12). Perioperative complications were bladder and urethral perforations in 2 and 1 cases, respectively (1.4%), and hematoma in 3 (1.4%). There was postoperative retention with a variable duration in 49 patients (23%), of whom 41 underwent Hegar dilation. Altogether 186 of 215 patients (86.5%) were cured of incontinence. Two patients were lost to followup and 14 (16.3%) had de novo urge incontinence. The cure rates were 87% for stress urinary incontinence and 91% for mixed incontinence. The cure rate in patients treated under local and spinal anesthesia were 82% and 91%, respectively (p = 0.1084). The rates for RS with recurrent vs primary incontinence were 84% vs 87% (p = 0.5800) and for RS with vs without Hegar dilation 80% vs 88% (p = 0.2094).

Conclusions: The technique described is simple, safe and inexpensive. The cure rates are comparable to those of tension-free vaginal tape. However, because of the relatively high rate of postoperative voiding difficulties compared to tension-free vaginal tape, this technique can be criticized. To avoid these problems special attention should be focused on applying the mesh without tension and with precision.