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PUBOVAGINAL SLING USING CADAVERIC FASCIA AND BONE ANCHORS: DISAPPOINTING EARLY RESULTS

2001; Lippincott Williams & Wilkins; Volume: 165; Issue: 5 Linguagem: Inglês

10.1016/s0022-5347(05)66358-6

1527-3792

Joseph M. Carbone, Elizabeth Kavaler, Jim C. Hu, Shlomo Raz,

Pelvic and Acetabular Injuries

No AccessJournal of UrologyCLINICAL UROLOGY: Female Urology1 May 2001PUBOVAGINAL SLING USING CADAVERIC FASCIA AND BONE ANCHORS: DISAPPOINTING EARLY RESULTS JOSEPH M. CARBONE, ELIZABETH KAVALER, JIM C. HU, and SHLOMO RAZ JOSEPH M. CARBONEJOSEPH M. CARBONE , ELIZABETH KAVALERELIZABETH KAVALER , JIM C. HUJIM C. HU , and SHLOMO RAZSHLOMO RAZ View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66358-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Pubovaginal sling procedures offer highly effective treatment for patients with female stress urinary incontinence. A recent modification of this technique is the use of cadaveric fascia lata as a sling material supported with titanium anchors placed bilaterally in the pubic bone. We reviewed our experience with this procedure and assessed our outcome. Materials and Methods: A total of 154 consecutive patients underwent a bone anchored, cadaveric fascia pubovaginal sling procedure by a single surgeon from July 1998 to June 1999. All patients were evaluated preoperatively with a detailed history, pelvic examination and radiographic or multichannel video urodynamic studies to diagnose stress urinary incontinence. Our technique begins with the nonincision placement of titanium bone anchors transvaginally into the pubic bone bilaterally. A 2 cm. wide tunnel is created bluntly beneath the vaginal epithelium between the 2 puncture sites with a right angle clamp. A 2 × 7 cm. strip of cadaveric fascia is then passed through the tunnel, into the retropubic space and secured to 2-0 polypropylene sutures attached to the anchors. After securing the sling, the transvaginal puncture sites are closed with 2-0 polyglactin sutures. Patients were seen postoperatively at 6 weeks, and 3 and 6-month followup. Patient age averaged 60 years (range 38 to 85), with an overall average length of followup from surgery of 10.6 months (range 6 to 16). All patients were mailed a self-administered questionnaire and participated in a telephone interview with an office nurse to retrospectively assess outcome and evaluate for recurrent stress urinary incontinence. Recurrent stress urinary incontinence was graded as 0—none, 1—rare, 2—moderate and 3—severe. Repeat pubovaginal sling procedure that was performed in patients with grades 2 to 3 stress urinary incontinence was considered a failure for the purpose of our study. Results: Of all 154 patients 58 (37.6%) had recurrent moderate to severe (grades 2 to 3) stress urinary incontinence at followup. A total of 26 patients underwent a second pubovaginal sling procedure for a reoperation rate of 16.9%. Intraoperative findings at reoperation revealed the titanium anchors to be in position, the polypropylene sutures to be intact, and retropubic fibrosis and scarring of the urethropelvic ligament suggesting appropriate retropubic placement of the sling in all cases. Uniformly all allogenic cadaveric fascia used for sling material appeared to be fragmented, attenuated or simply absent. Average time to reoperation was 9 months (range 3 to 15). Conclusions: Early results using a bone anchored cadaveric fascia pubovaginal sling procedure were discouraging. Based on findings at reoperation, we attribute this result to the failure of our sling material and have abandoned the use of cadaveric fascia allografts in all pubovaginal slings at our institution. References 1 : Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. J Urol1997; 158: 875. 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Google Scholar From the Danville Regional Medical Center, Danville, Virginia, Lenox Hill Hospital, New York, New York, and UCLA Medical Center, Los Angeles, California© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byDmochowski R, Blaivas J, Gormley E, Juma S, Karram M, Lightner D, Luber K, Rovner E, Staskin D, Winters J and Appell R (2018) Update of AUA Guideline on the Surgical Management of Female Stress Urinary IncontinenceJournal of Urology, VOL. 183, NO. 5, (1906-1914), Online publication date: 1-May-2010.Giri S, Hickey J, Sil D, Mabadeje O, Shaikh F, Narasimhulu G and Flood H (2018) The Long-Term Results of Pubovaginal Sling Surgery Using Acellular Cross-Linked Porcine Dermis in the Treatment of Urodynamic Stress IncontinenceJournal of Urology, VOL. 175, NO. 5, (1788-1793), Online publication date: 1-May-2006.SAMLI M and SINGLA A (2018) ABSORBABLE VERSUS NONABSORBABLE GRAFT: OUTCOME OF BONE ANCHORED MALE SLING FOR POST-RADICAL PROSTATECTOMY INCONTINENCEJournal of Urology, VOL. 173, NO. 2, (499-502), Online publication date: 1-Feb-2005.HO K, WITTE M and BIRD E (2018) 8-Ply Small Intestinal Submucosa Tension-Free Sling:: Spectrum of Postoperative InflammationJournal of Urology, VOL. 171, NO. 1, (268-271), Online publication date: 1-Jan-2004.SHAH D, PAUL E, RASTINEHAD A, EISENBERG E and BADLANI G (2018) Short-Term Outcome Analysis of Total Pelvic Reconstruction With Mesh:: The Vaginal ApproachJournal of Urology, VOL. 171, NO. 1, (261-263), Online publication date: 1-Jan-2004.QUEK M, GINSBERG D, WILSON S, SKINNER E, STEIN J and SKINNER D (2018) PUBOVAGINAL SLINGS FOR STRESS URINARY INCONTINENCE FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMENJournal of Urology, VOL. 172, NO. 1, (219-221), Online publication date: 1-Jul-2004.WILSON T, LEMACK G and ZIMMERN P (2018) Management of Intrinsic Sphincteric Deficiency in WomenJournal of Urology, VOL. 169, NO. 5, (1662-1669), Online publication date: 1-May-2003.SHAH D, PAUL E, AMUKELE S, EISENBERG E and BADLANI G (2018) Broad Based Tension-Free Synthetic Sling for Stress Urinary Incontinence: 5-Year OutcomeJournal of Urology, VOL. 170, NO. 3, (849-851), Online publication date: 1-Sep-2003.FLYNN B and YAP W (2018) PUBOVAGINAL SLING USING ALLOGRAFT FASCIA LATA VERSUS AUTOGRAFT FASCIA FOR ALL TYPES OF STRESS URINARY INCONTINENCE: 2-YEAR MINIMUM FOLLOWUPJournal of Urology, VOL. 167, NO. 2 Part 1, (608-612), Online publication date: 1-Feb-2002. (2018) EDITORIAL COMMENTJournal of Urology, VOL. 168, NO. 5, (2057-2058), Online publication date: 1-Nov-2002.KOBASHI K, LEACH G, CHON J and GOVIER F (2018) Continued Multicenter Followup of Cadaveric Prolapse Repair With Sling.Journal of Urology, VOL. 168, NO. 5, (2063-2068), Online publication date: 1-Nov-2002.O'REILLY K and GOVIER F (2018) INTERMEDIATE TERM FAILURE OF PUBOVAGINAL SLINGS USING CADAVERIC FASCIA LATA: A CASE SERIESJournal of Urology, VOL. 167, NO. 3, (1356-1358), Online publication date: 1-Mar-2002. Volume 165Issue 5May 2001Page: 1605-1611 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsurinary stress incontinencefasciacadavervaginapubic boneMetricsAuthor Information JOSEPH M. CARBONE More articles by this author ELIZABETH KAVALER More articles by this author JIM C. HU More articles by this author SHLOMO RAZ More articles by this author Expand All Advertisement PDF downloadLoading ...