The Use Of Polypropylene Mesh As A Transobturator Sling For The Treatment Of Female Stress Urinary Incontinence (Early Experience With 40 Cases)

Main Category: Urology / Nephrology
Also Included In: Women's Health / Gynecology
Article Date: 16 Mar 2008 - 0:00 PDT

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Urotoday.com - Urinary incontinence is a significant health problem in the developed and the developing countries. Various tissues and synthetic materials are used for that purpose. The transvaginal tape (TVT) procedure which uses a retropubic route has been associated with a number of complications resulting from penetrations of the surgical device into pelvic vessels, nerves and organs.(1) The transobturator tape (TOT) approach was developed for female SUI with the aim of avoiding the risk of urethra and bladder injuries with minimal vaginal dissection within a short period of time. The procedure is now the most popular technique in many world wide centers with good results.(2,3) In a developing country like Egypt, the cost of the tape is highly expensive; in this study we report our early experience in the use of polypropylene mesh, used in hernias repair, as a transobturator sling in the treatment of female SUI.

Patients and methods: For all patients, physical examination with cough stress test, urine culture and sensitivity and preoperative urodynamics examination were performed. Forty patients diagnosed with SUI underwent transobturator sling fashioned from the ordinary polypropylene mesh (vypro II®). Each lateral end of the tape was secured by a zero prolene suture and the procedure was then done outside-in. Cystocele and/or rectocele were performed before insertion of the sling in combined cases of SUI and pelvic floor lesions. In mild cases of cystocele, the insertion of the sling was enough without the need for cystocele repair. Follow up evaluation was performed at 1, 3, 6 and 12 months including physical examination, cough test, CUA, uroflowmetry with PVR measurement. Postoperative complications were recorded and including urinary retention, voiding difficulty, denovo urgency, recurrent urinary tract infection, vaginal or urethral erosion and dysparunia.

Results: The mean operative time was 40 and 60 minutes when the procedure was performed alone or accompanied with associated pelvic floor repair respectively. Complications of the procedure were controlled. Two cases (5 %) of remarkable intraoperative vaginal bleeding (> 200ml blood) were reported and managed, however there was no need for blood transfusion. Postoperatively, 35 patients (87.5 %) resumed normal voiding in the first postoperative day. Early postoperative voiding difficulty, within one week, was recorded in 5 patients (12.5 %). Within 2 weeks postoperatively, 3 patients (7.5 %) resumed normal voiding and only 2 patients (5 %) had persistent voiding difficulty. Thirty-five patients (87.5 %) cured, two patients (5 %) significantly improved, but the procedure failed in three patients (7.5 %) and the slings were removed due to vaginal erosion.

In conclusion, Polypropylene mesh transobturator sling is an easy and cheap method for the treatment of female SUI with a high success rate. It is a suitable method in developing countries as the commercial kits for TOT and TVT are very expensive.

1. Ulmsten U and Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29:75_82

2. Delorme E, Droupy S, deTayrac R and Delma V (2004) Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 45: 203_7

3. de Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724_30

Written by Abdelnaser K. H. Elgamasy, MD, Osama M. Elashry, MD, Mohammed A. Elenin, MD, Hassan H. Eltatawy, MD and Mahmoud D. Elsharaby, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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