A Novel Composite Sling for the Treatment of Stress Urinary Incontinence: First Clinical Experience

INTRODUCTION We face continuing challenges for the optimal form of treatment for stress urinary incontinence (SUI). Long-term outcome studies have revealed disappointing results for percutaneous needle suspensions and other sling substitutes secondary to failure due to the recurrence of urethral hypermobility or creation of urethral obstruction 1. The pubovaginal sling procedure is an established, reliable technique for correcting Type 3 (intrinsic sphincter defi ciency, ISD) SUI, and Type 2 SUI with coexisting ISD 2. Recently, the pubovaginal sling procedure has been popularized and used as a primary modality to treat all forms of SUI including urethral hypermobility (type 1 & 2) in the female patient 3. It is estimated that 30-65% of women with SUI present with mixed incontinence 4. Theoretically, preoperative irritative voiding symptoms (IVS) can also be corrected when the appropriate tension is applied to the sub-urethral sling relieving the traction on the pelvic nerves innervating the bladder 5. Weakness of the urethropelvic ligament (UPL) (endocervical and periurethral fascia) with its attachments to the arcus tendinous and urethra correlates with urethral hypermobility and SUI. This anatomical defect is a herniation of the pelvic contents. Anatomical corrective surgery has addressed these issues in the past with sub-optimal long-term results without the use of autologous or prosthetic sling material 2, 6-9. Many procedures have been utilized in order to attempt to re-support the UPL. If one were to reconstruct the fascia, one could potentially correct all forms of SUI secondary to urethral hypermobility. Complications of urethral sling procedures using a synthetic prosthesis have been reported: urethral obstruction, urinary retention, mesh erosion, extrusion, infection and nerve entrapment 10-11. A novel sling was designed to eliminate these inherent complications. The main objective of this operation is to address all anatomical concerns using a modifi ed Stamey approach. It is also designed to prevent the inherent complications seen with prosthetic material positioned underneath the urethra and bladder neck.