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Pubovaginal slings: Past, present and future

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Abstract

Renewed interest in the pubovaginal sling procedure for stress urinary incontinence has occurred in response to recent reports of poor durability and inconsistent efficacy associated with simple cystourethropexy. Many of the failures are felt to represent patients with an unrecognized component of intrinsic sphincteric deficiency. Historically slings have a favourable cure rate, but have been perceived as having unacceptably high rates of prolonged urinary retention and secondary detrusor instability. This article reviews the preoperative evaluation and indications for pubovaginal slings, describes the evolution of the current techniques, and discusses choice of sling material, surgical approach, results and complications. It is hoped that this review will stimulate interest in this versatile but technically challenging procedure.

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References

  1. Trockman BA, Leach GE, Hamilton J, Sakamoto M, Santiago L, Zimmern PE. Modified Pereyra bladder neck suspension: 10-year mean follow-up using outcomes analysis in 125 patients.J Urol 1995;154:1841–1847

    Article  PubMed  CAS  Google Scholar 

  2. Bernier PA, Kaplan EP, Djavan B, Roehrborn CG. Long term outcomes of women following transvaginal bladder neck suspension of stress urinary incontinence.J Urol 1995;153(Suppl):431A, Abstract

  3. Knispel HH, Klän R, Siegmann K, Miller K. Results with the Stamey procedure in 251 consecutive patients with genuine stress urinary incontinence.J Urol 1995;153(Suppl):431A, Abstract

  4. Sirls LT, Keoleian CM, Korman HJ, Kirkemo AK. The effect of study methodology on reported success rates of the modified Pereyra bladder neck suspension.J Urol 1995;154:1372–1735

    Article  Google Scholar 

  5. McGuire EJ, Lytton BP, Kohorn EI, Pepy V. The value of urodynamic testing and stress urinary incontinence.J Urol 1980;124:256

    PubMed  CAS  Google Scholar 

  6. Goebell R. Zur operativen beseitigung der angebornen incontinentia vesicae.Zeitscher Gynäkol 1910;2:187–191

    Google Scholar 

  7. Frangenheim P. Zu operativen behandlung der inkontinenz der mannlichen harnohre.Verh Dtsch Ges Chir 1914;43:149–154

    Google Scholar 

  8. Stoeckel W. Uber die verwendung der museuli pyramidalis bei der operativen behandlung der incontinentia urinae.Zentralbl Gynäkol 1917;41:11–19

    Google Scholar 

  9. Miller NF. The surgical treatment of urinary incontinence in the female.JAMA 1932;98:628

    Google Scholar 

  10. Aldridge AH. Transplantation of fascia for relief of urinary stress incontinence.Am J Obstet Gynecol 1942;44:398–411

    Google Scholar 

  11. Ridley JH. Surgical treatment of stress incontinence in women.JMA Georgia 1955;94:135

    Google Scholar 

  12. Williams TJ, Telinde RW. The sling operation for urinary incontinence using Mersilene ribbon.Obstet Gynecol 1962;19:241–245

    PubMed  CAS  Google Scholar 

  13. Moir JC. The gauze hammock operation.J Obstet Gynaecol Br Commonw 1968;75:1–9

    PubMed  CAS  Google Scholar 

  14. Morgan JE. A sling operation using Marlex polypropylene mesh for treatment of recurrent stress incontinence.Am J Obstet Gynecol 1970;106:369–377

    PubMed  CAS  Google Scholar 

  15. Stanton SL, Brindley GS, Holmes DM. Silastic sling for urethral sphincter incompetence in women.Br j Obstet Gynaecol 1985;92:747–759

    PubMed  CAS  Google Scholar 

  16. Faber P, Beck L, Heidenreich J. Treatment of stress urinary incontinence in women with the Lyodura sling.Urol Int 1978;33:117–119

    Article  Google Scholar 

  17. Iosif CS. Porcine corium sling in the treatment of urinary stress incontinence.Arch Gynecol 1987;240:131–136

    Article  PubMed  CAS  Google Scholar 

  18. Fianu S, Söderberg G. Absorbable polyglactin mesh for retropubic sling operations in female urinary stress incontinence.Gynecol Obstet Invest 1983;16:45–50

    PubMed  CAS  Google Scholar 

  19. McGuire EJ, Lytton B. Pubovaginal sling procedure for stress incontinence.J Urol 1978;119:82–84

    PubMed  CAS  Google Scholar 

  20. Blaivas JG, Jacobs BZ. Pubovaginal sling in the treatment of complicated stress incontinence.J Urol 1991;145:1214–1218

    PubMed  CAS  Google Scholar 

  21. Raz S. Modified bladder neck suspension for female stress incontinence.Urology 1981;17:82–85

    Article  PubMed  CAS  Google Scholar 

  22. Fokaefes ED, Lampel P, Hohenfellner M, Lazica M, Thüroff JW. Experimental evaluation of the free versus pedicled fascial flaps for sling surgery of stress urinary incontinence.J Urol 1997;157:1039–1043

    Article  Google Scholar 

  23. McGuire EJ, Bennett CJ, Konnak JA, Sonda P, Savastano JA. Experience with pubovaginal slings for urinary incontinence at the University of Michigan.J Urol 1987;138:525–526

    PubMed  CAS  Google Scholar 

  24. Blaivas JG, Salinas J. Type III stress urinary incontinence: importance of proper diagnosis and treatment.Surg Forum 1984;35:473

    Google Scholar 

  25. Mason RC, Roach M. Modified pubovaginal sling for treatment of intrinsic sphincteric deficiency.J Urol 1996;156:1991–1994

    Article  Google Scholar 

  26. Govier FE, Gibbons RP, Correa RJ, Weissman RM, Pritchett TR, Hefty TR. Pubovaginal slings using fascia lata for the treatment of intrinsic sphincteric deficiency.J Urol 1997;157:117–121

    Article  PubMed  CAS  Google Scholar 

  27. Carr LK, Walsh PJ, Abraham VE, Webster GD. Favorable outcome of pubovaginal slings for geriatric women with stress incontinence.J Urol 1997;157:125–128

    Article  PubMed  CAS  Google Scholar 

  28. Govier FE, Pritchett TR, Kornman JD. Correlation of the cystoscopic appearance and functional integrity of the female urethral sphincteric mechanism.J Urol 1994;44:250–252

    Article  CAS  Google Scholar 

  29. Dupont MC, Albo ME, Raz S. Diagnosis of stress urinary incontinence.Urol Clin North Am 1996;23.3:407–415

    Google Scholar 

  30. Haab F, Zimmern PE, Leach GE. Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management.J Urol 1996;156:3–17.

    Article  Google Scholar 

  31. Smith DN, Appell RA, Winters JC, Rackley RR. Collagen injection therapy for female intrinsic sphincteric deficiency.J Urol 1997;157:1275–1278

    Article  PubMed  CAS  Google Scholar 

  32. Berman CJ, Kreder KJ. Comparative cost analysis of collagen injection and fascia lata sling cystourethropexy for the treatment of type III incontinence in woman.J Urol 1997;157:122–124

    Article  PubMed  CAS  Google Scholar 

  33. Appell RA, McGuire EJ, De Ridder PA et al. Summary of effectiveness and safety in the prospective, open, multicenter investigation of collagen implant for incontinence due to intrinsic sphincteric deficiency in females.J Urol 1994;151:418A, Abstract

    Google Scholar 

  34. Stricker P, Haylen B. Injectable collagen for type 3 female stress incontinence: the first 50 Australian patients.Med J Aust 1993;158:89–93

    PubMed  CAS  Google Scholar 

  35. Monga AK, Robinson D, Stanton SL. Periurethral collagen injections for genuine stress incontinence: a 2-year follow-up.Br J Urol 1995;76:156

    PubMed  CAS  Google Scholar 

  36. Moore KN, Chetner MP, Metcalfe JB, Griffith DK. Periurethral implantation of glutaraldehyde cross-linked collagen (Contigen) in women with type I or III stress incontinence: quantitative outcome measures.Br J Urol 1995;75:359

    Article  PubMed  CAS  Google Scholar 

  37. Govier FE. Is periurethral collagen a reasonable long-term treatment option for ISD? Urodynamics Society Meeting, New Orleans, LA, 4/12/97 (poster)

  38. Stothers L, Goldenberg L, Leone E, Werkington M. Long term follow up and outcome analysis of collagen injection for the treatment of female stress urinary incontinence. Urodynamic Society 18th Annual Meeting, 5/4/96, Orlando, Florida

  39. Hadley HR, Loisides P, Dickinson M. Long term followup (2.5 years) of transvaginally placed artificial urinary sphincters by an experienced surgeon.J Urol 1995;4:153(Suppl)432A, Abstract

    Google Scholar 

  40. Mark SD, Webster GD. Stress urinary incontinence due primarily to intrinsic sphincter deficiency: experience with artificial urinary sphincter and sling cystourethropexy.J Urol 1994;151(Part 2):420A, Abstract

  41. Raz S, Siegal AL, Short JL, Snyder JA. Vaginal wall sling.J Urol 1989;141:43–46

    PubMed  CAS  Google Scholar 

  42. Kaplan SA, Santarosa RP, Te AE. Comparison of fascial and vaginal wall slings in the management of intrinsic sphincteric deficiency.Urology 1996;47:885–889

    Article  Google Scholar 

  43. Handa VL, Jensen JK, Germain MM, Ostergard DR. Banked human fascia lata for the suburethral sling procedures: a preliminary report.Obstet Gynecol 1996;88:1045–1049

    Google Scholar 

  44. Couillard DR, Deckard-Janatpour KA, Stone AR. The vaginal wall sling: a compressive suspension procedure for recurrent incontinence in elderly patients.Urology 1994;43:203–208

    Article  PubMed  CAS  Google Scholar 

  45. Webster GD, Kreder KJ. Voiding dysfunction following cystourethropexy: its evaluation and management.J Urol 1990;144:670–673

    PubMed  CAS  Google Scholar 

  46. Carr LK, Webster GD. Bladder outlet obstruction in women.Urol Clin North Am 1996;23:385–391

    Article  Google Scholar 

  47. Raz S, Stothers L, Young GPM et al. Vaginal wall sling for anatomical incontinence and intrinsic sphincteric dysfunction: efficacy and outcome analysis.J Urol 1996;156:166–170

    Article  Google Scholar 

  48. Jarvis GJ. Review: surgery for genuine stress incontinence.Br J Obstet Gynaecol 1994;101:371–374

    PubMed  CAS  Google Scholar 

  49. Beck RP, McCormick S, Nordstrom L. The fascia lata sling procedure for treating genuine stress incontinence of urine.Obstet Gynecol 1988;72:699–703

    PubMed  CAS  Google Scholar 

  50. Morgan JE, Heritz DM, Stewart FE, Connelly JC, Farrow GA. The polypropylene pubovaginal sling for the treatment of recurrent stress urinary incontinence.J Urol 1995;154:1013–1015

    Article  PubMed  CAS  Google Scholar 

  51. Melnick I, Lee R. Delayed transection by urethral Mersilene tape.Urology 1976;8:580–581

    Article  PubMed  CAS  Google Scholar 

  52. Morgan JE, Farrow GA, Stewart FE. The Marlex sling operation for the treatment of recurrent stress urinary incontinence.Am J Obstet Gynecol 1985;151:224

    PubMed  CAS  Google Scholar 

  53. Woodside JR, Borden TA. Pubovaginal sling procedure the management of urinary incontinence in a myelodysplastic girl.J Urol 1982;127:744–746

    PubMed  CAS  Google Scholar 

  54. McGuire EJ, Wang C, Usitalo H, Savastano J. Modified pubovaginal sling in girls with myelodysplasia.J Urol 1986;135:94–96

    PubMed  CAS  Google Scholar 

  55. Elder JS. Periurethral and puboprostatic sling repair for patients with myelodysplasia.J Urol 1990;144:434–437

    PubMed  CAS  Google Scholar 

  56. Woodside JR. Pubovaginal sling procedure for the management of urinary incontinence after urethral trauma in women.J Urol 1987;138:527–528

    PubMed  CAS  Google Scholar 

  57. Gormley EA, Bloom DA, McGuire EJ, Ritchley ML. Pubovaginal slings for the management of urinary incontinence in female adolescents.J Urol 1994;152:822–825

    PubMed  CAS  Google Scholar 

  58. Jorion JL. Rectus fascial sling suspension of the vesicourethral anastomosis after radical prostatectomy.J Urol 1997;157:926–928

    Article  PubMed  CAS  Google Scholar 

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Sarver, R., Govier, F.E. Pubovaginal slings: Past, present and future. Int Urogynecol J 8, 358–368 (1997). https://doi.org/10.1007/BF02765597

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