INTRODUCTION AND OBJECTIVES: Midurethral sling is a standard primary surgical procedure for female stress urinary incontinence (SUI). Retropubic (RP) sling shows higher effectiveness than transobturator (TO) in patients with recurrent SUI. At the time, bladder outlet obstruction (BOO) is a common complication of RP sling. The purpose of the study was to evaluate the effectiveness and safety of retropubic adjustable sling in patients with complicated SUI.
METHODS: Our study comprised 43 women suffering from SUI and who had one or more predictors of surgical failure such as previous anti-incontinence surgery or pelvic organ prolapse repair, intrinsic sphincter deficiency, severe SUI and concomitant morbidity. All patients underwent RP adjustable sling insertion. We used monofilament polypropylene sling with special threads, which allow to tune its tension during 2 days after surgery. The pre- and postoperative evaluation included urogynecological history, vaginal examination, cough stress test (CST), urodynamic study, bladder ultrasound and post-void residual urine volume (PVR) measurement, 1-hour Pad-test, questionnaires (UDI-6, UIQ-6, PFIQ-7, ICIQ-SF).
RESULTS: Mean surgery time was 27,510,1 min. There were no cases of intraoperative bladder injury or clinically significant bleeding. The next day after surgery 25 patients (51,8%) required tension adjustment. The tension was increased in 14 (32,5%) patients presented with positive CST and decreased in 11 (25,6%) patients, who had obstructive flow pattern, complaints of a slow or intermittent stream and PVR>100 ml. This procedure was repeated in 7 (16,3%) because of positive CST at the following examination. After adjustment, all patients were continent, with PVR 60 ml. There were no cases of BOO or urinary retention after tension adjustment. None of the patients required intermittent or indwelling catheterization. Mean follow-up was 8.84.4 months.The objective cure rate was 95,4% (n¼41). There was no significant decrease of Qmax (p>0,05). We had 3 (6,9%) cases of vaginal mesh extrusion in patients who had a history of vaginal mesh surgery. None of them underwent tension adjustment. There were no cases of wound infections, chronic pain or dyspareunia and no cases of BOO during follow-up. The questionnaires scores showed 88,3% (n¼38) patients to be very satisfied with great improvement of the quality of life (p<0,001).
CONCLUSIONS: The adjustable retropubic sling is a good option for treating patients with risk factors of failure. It provides high objective and subjective cure rate and low complication number. At the same time, it allows to minimize the risk of postoperative voiding dysfunction
