Tags

Type your tag names separated by a space and hit enter

Spiral sling salvage anti-incontinence surgery in female patients with a nonfunctional urethra: technique and initial results.
J Urol. 2006 May; 175(5):1794-8; discussion 1798-9.JU

Abstract

PURPOSE

Female patients with severe urethral incompetence are a unique surgical challenge. Urethral closure and continent diversion are often the next step in the treatment of these patients. We present a technique that provides circumferential coaptation of the urethra as a salvage procedure in this severe subset of patients.

MATERIALS AND METHODS

We prospectively evaluated 47 patients who had a spiral sling. A 1 x 15 cm piece of soft polypropylene mesh was prepared with a zero polyglactin suture applied at each end. A clamp was used to pass the mesh between the urethra and pubis. The ends of the mesh were crossed at the ventral aspect of the urethra, creating a complete circle around the urethra. The sutures were transferred to the suprapubic area and tied without tension. The surgical outcome was determined by patient self-assessment, including symptom, bother and quality of life questionnaires.

RESULTS

Mean patient age was 59 years. At presentation patients had undergone a mean of 2.6 incontinence procedures and wore a mean of 6 pads daily. Mean daily pad use decreased to 0.9 (p <0.005). Preoperatively mean SUI symptom severity and bother scores were 2.8 and 2.9, respectively, on a scale of 0--none to 3--severe. Postoperatively these values decreased to 0.6 and 0.4, respectively (each p <0.005). There was a mean 87% overall improvement in symptoms.

CONCLUSIONS

The spiral sling is an effective salvage transvaginal procedure that may be considered in a small subset of female patients with a nonfunctional urethra as a last resort before urethral closure procedures.

Authors+Show Affiliations

Department of Urology, Columbia University School of Medicine, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

16600764

Citation

Rutman, Matthew P., et al. "Spiral Sling Salvage Anti-incontinence Surgery in Female Patients With a Nonfunctional Urethra: Technique and Initial Results." The Journal of Urology, vol. 175, no. 5, 2006, pp. 1794-8; discussion 1798-9.
Rutman MP, Deng DY, Shah SM, et al. Spiral sling salvage anti-incontinence surgery in female patients with a nonfunctional urethra: technique and initial results. J Urol. 2006;175(5):1794-8; discussion 1798-9.
Rutman, M. P., Deng, D. Y., Shah, S. M., Raz, S., & Rodríguez, L. V. (2006). Spiral sling salvage anti-incontinence surgery in female patients with a nonfunctional urethra: technique and initial results. The Journal of Urology, 175(5), 1794-8; discussion 1798-9.
Rutman MP, et al. Spiral Sling Salvage Anti-incontinence Surgery in Female Patients With a Nonfunctional Urethra: Technique and Initial Results. J Urol. 2006;175(5):1794-8; discussion 1798-9. PubMed PMID: 16600764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spiral sling salvage anti-incontinence surgery in female patients with a nonfunctional urethra: technique and initial results. AU - Rutman,Matthew P, AU - Deng,Donna Y, AU - Shah,Sovrin M, AU - Raz,Shlomo, AU - Rodríguez,Larissa V, PY - 2005/06/20/received PY - 2006/4/8/pubmed PY - 2006/6/16/medline PY - 2006/4/8/entrez SP - 1794-8; discussion 1798-9 JF - The Journal of urology JO - J Urol VL - 175 IS - 5 N2 - PURPOSE: Female patients with severe urethral incompetence are a unique surgical challenge. Urethral closure and continent diversion are often the next step in the treatment of these patients. We present a technique that provides circumferential coaptation of the urethra as a salvage procedure in this severe subset of patients. MATERIALS AND METHODS: We prospectively evaluated 47 patients who had a spiral sling. A 1 x 15 cm piece of soft polypropylene mesh was prepared with a zero polyglactin suture applied at each end. A clamp was used to pass the mesh between the urethra and pubis. The ends of the mesh were crossed at the ventral aspect of the urethra, creating a complete circle around the urethra. The sutures were transferred to the suprapubic area and tied without tension. The surgical outcome was determined by patient self-assessment, including symptom, bother and quality of life questionnaires. RESULTS: Mean patient age was 59 years. At presentation patients had undergone a mean of 2.6 incontinence procedures and wore a mean of 6 pads daily. Mean daily pad use decreased to 0.9 (p <0.005). Preoperatively mean SUI symptom severity and bother scores were 2.8 and 2.9, respectively, on a scale of 0--none to 3--severe. Postoperatively these values decreased to 0.6 and 0.4, respectively (each p <0.005). There was a mean 87% overall improvement in symptoms. CONCLUSIONS: The spiral sling is an effective salvage transvaginal procedure that may be considered in a small subset of female patients with a nonfunctional urethra as a last resort before urethral closure procedures. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/16600764/Spiral_sling_salvage_anti_incontinence_surgery_in_female_patients_with_a_nonfunctional_urethra:_technique_and_initial_results_ L2 - https://www.jurology.com/doi/10.1016/S0022-5347(05)00988-2?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -