In a nutshell
This study looked at the long term safety and effectiveness of vaginal slings to treat stress urinary incontinence (SUI). It concluded that this procedure is effective for SUI long term but has a raised complication rate.
Some background
Stress incontinence is urine leakage when there is pressure on the bladder. It is often observed when a patient coughs, sneezes or exercises. Stress incontinence happens as a result of weak muscles around the bladder that hold urine in.
Urinary incontinence can be treated by pelvic floor exercises, drug therapy, pessaries (to support the walls of the bladder) or nerve stimulation. Surgery can also be an option when these treatments do not work, but it is only effective for stress incontinence.
Surgical slings are used for surgery for stress incontinence. Most stress incontinence problems are caused by bladder neck weakness. Surgeons insert a sling which then supports the bladder neck and stops urine leakage. Tension-free vaginal tape-obturator is a type of sling.
Methods & findings
87 patients with SUI were included in this study. These patients were followed for 12 years. They were assessed for procedure satisfaction, complications, stress test results (an incontinence test), quality of life and sexual function.
73 (84%) of patients were available at 12 years after surgery. 45.2% of patients experienced at least one complication in 12 years. 12.3% of patients developed overactive bladder symptoms. 8.2% of patients experienced recurrent urinary tract infections. 21.9% of patients had changed urination. This included a slower flow of urine, or only being able to urinate in specific positions. One patient reported continuing pain in their groin. Two patients reported pain during sexual intercourse. Four patients (5.5%) had exposed tape. One patient had another incontinence surgery during the study period.
At 12 years, 82.2% of patients were cured. 80.8% of patients were satisfied with the procedure. SUI and sexual function improved in all patients.
The bottom line
The study concluded that vaginal slings were effective long term for SUI. It also concluded that there was a relatively high complication rate.
The fine print
The authors note that 4 patients had exposed tape causing some complications. They also note that the questionnaires used were not validated. These factors may affect the study's results.
What’s next?
If you are interested in learning more about vaginal slings to treat SUI, talk to your doctor.
Published By :
BJU international
Date :
Sep 24, 2018
