Major Finding: The single-incision midurethral sling had an 89% cure rate for stress urinary incontinence at 1 year.
Data Source: Prospective study of 31 patients.
Disclosures: None reported.
KISSIMMEE, FLA. — The single-incision midurethral sling is a safe and effective treatment for stress urinary incontinence, with an 89% cure rate at 1 year after the procedure, based on the results of a small prospective study.
Although the intraoperative complication rate was low—6%—a cystoscopy should be performed immediately after the sling procedure to rule out any inadvertent urogenital injury, Dr. Bilal Kaaki said at the annual meeting of the AAGL.
In his series, “there were two intraoperative complications—one bladder perforation and a urethral perforation,” said Dr. Kaaki, an ob.gyn in Waterloo, Iowa. “A cystoscopy can rule out any such injuries.”
Dr. Kaaki reported on his series of 31 patients who underwent the procedure at Allen Memorial Hospital in Waterloo.
The patients' average age was 56 years (range, 35-82 years).
Their mean body mass index was 32 kg/m
The sling—a hammock-shaped polypropylene mesh—was inserted transvaginally through a single incision at the midurethral level.
The self-fixating tips were anchored in the obturator internus muscles.
Tension was adjusted intraoperatively by response to the cough stress test.
Patient response was measured at baseline and at 1 week, 2 months, and 1 year after the surgery. Measures included the cough stress test, the Urogenital Distress Inventory Short Form (UDI-6), and the Incontinence Impact Questionnaire (IIQ-7).
At 1 week, there was an objective cure rate of 92%, as measured by a negative finding on a standing cough stress test. The patients who failed the stress test at 1 year also had reported stress incontinence at the 2-month visit, but elected to have no further treatment, Dr. Kaaki said.
At 1-year follow-up, the cure rate was 89%. Compared with baseline scores, scores at 1 year on both the UDI-6 and IIQ-7 were significantly reduced. Changes in these scores were not significantly associated with age, body mass index, parity, or prior surgery.
Also at 1 year, 60% of the group reported the surgery as “very successful,” and 35% reported it as “moderately successful.”
There were three postoperative complications: two cases of urinary retention that required release of the surgical tape and one case of pyelonephritis. There were no erosions, extrusions, or infections, and no hematomas or blood transfusions.
Dr. Kaaki said the procedure has the potential of being performed in the office, but more research is needed for validation.