Broad Based Tension-Free Synthetic Sling for Stress Urinary Incontinence: 5-Year Outcome

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Abstract
Purpose: The use of nonabsorbable synthetic material has been questioned due to reports of erosion and infection. We present the 5-year followup outcome of stress urinary incontinence (SUI) treated using polypropylene mesh as a pubovaginal sling. Materials and Methods: A retrospective analysis was performed of 58 consecutive patients who underwent pubovaginal sling procedures using polypropylene mesh since April 1996 for types II and III SUI at our institution. The technique included a single midline anterior vaginal wall incision with full-thickness flaps. Broad based polypropylene mesh was used to support the vesicourethral junction entering the retropubic space through the endopelvic fascia and bone anchors were used for fixation. Patient satisfaction was evaluated during followup office visits and/or telephone interview by an individual not involved in any surgeries. All procedure failures were evaluated by urodynamics. Results: Of the 58 patients 49 were available for analysis. Average followup was 59.34 months (range 29 to 77). Of the 49 patients 40 (81.63%) were dry and 2 (4.08%) improved (1 pad daily). De novo urgency and urgency related incontinence was reported in 1 case each. Three patients (8.16%) had recurrent SUI, while prolonged retention developed with subsequent urethrolysis required in 2 (4.08%). None of the patients have experienced infection, nonhealing or erosion of the synthetic slings to date. Conclusions: In our experience polypropylene mesh used as a broad based tension-free sling was successful for treating all types of SUI. In our opinion technique and case selection have a bearing on outcomes.