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POLYPROPYLENE MESH IN STRESS URINARY INCONTINENCE

Author: Liqaa R Al-Khuzaee لقاء رياض الخزرجي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 4 Pages: 332-337
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

BackgroundThe pubovaginal sling (PVS) is a safe and durable surgical procedure for stress urinary incontinence (SUI) of all types. Among numerous modifications of the procedure is using synthetic sling material to decrease surgical morbidity and increase long-term success.ObjectiveTo present the results of pubovaginal sling with a polypropylene mesh in women with SUI.MethodsWe studied 12 consecutive patients who underwent PVS procedure using polypropylene mesh for SUI between January 2008 and April 2009. Stress urinary incontinence was demonstrated by positive cough test, filling cystometry. Urethral hyper mobility was demonstrated with straining cotton swab (≥ 30◦), with different grades of vaginal wall prolapse. Urodynamic study was not performed. All these patients were treated with pubovaginal sling (PVS) with a low-cost polypropylene mesh confectioned by the surgeon. The sling was placed at the level of the proximal half of the urethra and tied with adequate tension, but not obstructing the bladder outlet. Postoperatively, the patients were evaluated at 6-month with a symptom questionnaire, physical examination, and postvoid residual volume determination. Demographic criteria, complications during surgery and post operative period, and subjective cure rate at three months were assessed.ResultsTwelve patients with mean age of 55.5 years and median parity of 4 years underwent bladder neck sling surgery using polypropylene mesh. Body weight range was 45-68 kg. No intraoperative or major postoperative complications were reported. Mean duration of surgery was 65.5 minutes (60-120 minutes). Concomitant procedures were performed, including cystocele repair (n= 10) rectocele repair (n=11). Mean duration of hospital stay was 2 days (1-5 days). Ten patients had complete cure of SUI, one patient had significant decrease in the severity of stress urinary incontinence. One patient had persistent SUI.ConclusionsThe construction of a pubovaginal sling using a low-cost polypropylene mesh is a safe and effective technique for the relief of SUI. It should be considered an alternative, especially in patients with weak rectus fascia.Key wordsstress urinary incontinence; pubovaginal slings; polypropylene

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