Use of surgeon-tailored polypropylene mesh as a needle-less single-incision sling for treating female stress urinary incontinence: Preliminary results

Mohammed S ElSheemy; Hisham Ghamrawy; Hesham Fathy; Hussein A Hussein; Eman A Hussein; Ahmed Aly; Sherif Abdel Rahman

doi:10.1016/j.aju.2015.04.003

Use of surgeon-tailored polypropylene mesh as a needle-less single-incision sling for treating female stress urinary incontinence: Preliminary results

Arab J Urol. 2015 Sep;13(3):191-8. doi: 10.1016/j.aju.2015.04.003. Epub 2015 Jun 14.

Authors

Mohammed S ElSheemy¹, Hisham Ghamrawy¹, Hesham Fathy¹, Hussein A Hussein¹, Eman A Hussein², Ahmed Aly¹, Sherif Abdel Rahman¹

Affiliations

¹ Urology Department, Kasr Al-Ainy Hospital, Cairo University, Egypt.
² Department of Gynecology and Obstetrics, Cairo University, Cairo, Egypt.

Abstract

Objective: To evaluate the safety and efficacy of a procedure using surgeon-tailored polypropylene mesh (STM) through a needle-less single-incision technique for treating stress urinary incontinence (SUI), aiming to decrease the cost of treatment, which is important in developing countries.

Patients and methods: In all, 43 women diagnosed using a cough stress test were treated from January 2011 to June 2013 at the Urology and Gynaecology Departments (dual-centre), Cairo University Hospitals. Previous surgery was not a contra-indication. Patients with a postvoid residual urine volume of >100 mL, a bladder capacity of <300 mL, impaired compliance or neurological lesions were excluded. The Stress and Urge incontinence Quality of life Questionnaire (SUIQQ) and urodynamic variables were compared before and after surgery. The variables were compared between the baseline and postoperative follow-up values using a paired t-test, a Wilcoxon signed-rank test or McNemar's test.

Results: The mean age was 42.7 years and 20 (47%) patients had associated urgency UI (UUI), whilst 21 (49%) had intrinsic sphincter deficiency. The median (range) operative duration was 14 (5-35) min. There were no complications during surgery. The mean (SD, range) follow-up was 28.1 (5.1, 18-36) months. Postoperative complications were vaginal discharge (5%), failure of wound healing (5%), dyspareunia (5%) and UTI (5%). The sling was removed in one case. SUI, UUI and quality-of-life indices improved significantly after surgery. There were no significant differences in pressure-flow studies before and after surgery. In all, 38 (88%) patients were cured, four (9%) improved and in one only the treatment failed (2%).

Conclusion: This technique is simple, safe, effective, reproducible and economical for treating SUI. The STM was easy to insert in a short operation.

Keywords: (M)(U)(S)UI, (mixed) (urge) (stress) urinary incontinence; ALPP, abdominal leak-point pressure; CST, cough stress test; DO, detrusor overactivity; Female; ISD, intrinsic sphincter deficiency; NSIT, needle-less single-incision technique; PVR, postvoid residual urine; PdetQmax, detrusor pressure at maximum urinary flow rate; Polypropylene mesh; Qmax, maximum urinary flow rate; QoL, quality of life; STM, surgeon-tailored ordinary polypropylene mesh; SUI, stress urinary incontinence; SUIQQ, Stress and Urge Incontinence Quality of life Questionnaire; Single incision; Stress urinary incontinence; TVT, tension-free vaginal tape.