Ces Urol 2004, 8(3):34-41 | DOI: 10.48095/cccu2004019

Sling methods in surgical treatment of stress incontinence in women

K. Mainer¹, J. Krhut¹, J. Kopecký¹, F. Záťura²

¹ urologické oddelení FNsP Ostrava

² Urologická klinika LF UP a FN Olomouc, přednosta doc. MUDr. František Záťura

It was the objective of the operation to evaluate the issue of therapy of stress incontinence in women (SI), especially from the point of surgical procedures, to analyse the sets of patients operated using the pubovaginal sling (PVS) and tension free vaginal tape (TVT) methods, to compare these sling methods with colposuspension according Burch. The patients were indicated for operation (assigned to the set) based on complex examination based on the algorithm followed in our department. We indicated operation in patients suffering from clean stress incontinence or combined form of incontinence (stress and detrusor hyperactivity, up to urgent incontinence). Based on evaluation of operation efficiency (suppression of SI symptoms) the success rate of 98 % was achieved, or 97 % respectively, during more than 5-year monitoring (in the event PVS). In conformance with literature we confirmed the permanent effect of sling operations. Post-operation quality of life in patients treated using the PVS methods was comparable to colposuspension method according to Burch, when satisfaction was reported by 89 % of patients; satisfaction in TVT set was even higher, 96 % of the patients reported satisfaction with the operation. Assessing of complications connected with operation treatment focuses primarily on the most serious ones, which are the failure to suppress symptoms of SI, temporary and permanent hypercorrection and dissatisfaction about the post-operation result. Lower number of serious complications was reported in TVT set, where this result is probably due to lower per-operation traumatism of the target structures. In the event of dysfunctional urination and permanent hypercorrection we emphasize adequate examination (including videourodynamics) and ensuring conservative procedures that would mostly avoid the need of operation (urethrolysis and discission of sling). If the conservative treatment does not result in desired effect, we indicate sling discission upon expiry of at least three, but preferably six months. Comparison of results of sling operations with colposuspension according to Burch, which is the considered the "golden standard" in SI therapy, both these sling methods offer better results.

Keywords: stress incontinence, operation treatment, pubovaginal sling, TVT

Published: June 1, 2004