The intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence in the female

Abstract

The aim was to evaluate the intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence. Fifty-four unselected patients, aged from 26 to 79 years, mainly with mixed incontinence symptoms, underwent this procedure. It works by tightening the suburethral vagina ('hammock'), and by creating an artificial pubourethral neoligament. Where indicated, repair of uterine prolapse (24 cases), or infracoccygeal sacropexy (17 cases) was also performed. Almost all patients were discharged on the day of, or day after surgery, without requirement for postoperative catheterization, and returned to fairly normal activities, including jobs, within 7 to 14 days. At a mean follow-up time of 15 months, the cure rates for preoperative symptoms were, frequency 88%, nocturia 77%, urge incontinence 89%, stress incontinence (SI) 85%, symptoms of abnormal emptying, 77%, and reduction of mean residual urine from 67.5 mL to 32 mL. The objective cure rate (exercise pad testing) for stress incontinence was 88.6%; taking the group as a whole, urine loss was reduced from a mean of 11.6 g preoperatively to a mean of 0.5 g postoperatively. Urodynamically diagnosed detrusor instability was not a predictor of surgical failure in this study. According to the concepts presented here, symptoms of urinary dysfunction are mainly symptomatic manifestations of abnormal laxity in the vagina or its supporting ligaments. The surgical methods used to correct these defects are fairly simple, safe and easily learnt by an practising gynaecologist.