A follow up of silastic sling for genuine stress incontinence.

OBJECTIVE

To assess the use of silastic sling for genuine stress incontinence.

DESIGN

Retrospective descriptive analysis.

SETTING

Tertiary referral centre for urogynaecology.

SUBJECTS: Eighty-eight women with urodynamically proven genuine stress incontinence, 10 had coexistent detrusor instability. In 74 women, the sling operation was for recurrent incontinence.

INTERVENTION: A low Pfannenstiel incision was used and a suburethral tunnel dissected to insert the sling, which was attached under minimal tension with non-absorbable sutures to each ileopectineal ligament.

MAIN OUTCOME MEASURES: Clinical and urodynamic data were assessed between two and three months post-surgery; thereafter clinical assessment and pad testing were performed at yearly intervals for five years.

RESULTS

The subjective cure at three months was 81% and the objective cure was 69%. There was a fall in success rate with increasing number of continence operations, and this was statistically significant for women with three or more previous continence operations (P < 0.05). Neither age, parity nor menopausal status made a statistical difference to the cure rate. Twenty-three women had reached their fifth year follow up and the success rate using life table analysis was 71%. Post-operatively, 29 women had detrusor instability: 22 women developed detrusor instability de novo and seven had detrusor instability presurgery. Urodynamic findings postsurgery showed an increase (P < 0.001) in outflow resistance. Four women required removal of sling for voiding difficulties. Ten women developed sling erosions: five vaginal, four bladder erosions and one urethral erosion. After removal of the sling, seven women still remained continent.

CONCLUSIONS

A silastic sling operation for the treatment of genuine stress incontinence provides a good long term cure, considering that 45% of women had two or more previous failed continence operations. The high prevalence of detrusor instability and voiding difficulties postsurgery should be noted.