Bone-anchored suburethral sling: Surgical technique and outcomes

Abstract

The gold standard treatment for stress urinary incontinence (SUI) is the autologous rectus fascia pubovaginal sling. Although successful, it is associated with increased morbidity related to the graft harvest. Because of this, less invasive techniques were developed, including the retropubic and trans-obturator midurethral sling and the bone-anchored sling (BAS). Early reported outcome failures and concern for bone-anchored-related complications caused BAS to fall out of favor. However, technique modifications and use of a more durable graft or mesh have proven that the transvaginal placement of BAS is actually safe and effective in treating patients with SUI. Further, recent evidence suggests that the bone-anchored sling may be a reasonable option for treatment of patients with moderate to severe and/or recurrent SUI.

Female incontinence

“…According to a 4-year follow-up study [58], with a high rate of early and late reported outcome failures, BAS fell out of favor. Although postoperative osteomyelitis is rare, each case incurs a substantial morbidity and a complicated postoperative course Therefore, the BAS procedure cannot be proposed for correction of SUI [58][59][60]. The estimated incidence of osteomyelitis after bone-anchored bladder neck suspension was 1.3% [59].…”

Long-Term Follow-up of Polypropylene Bone Anchored Slings

“…BAS were mainly used for indications of intrinsic sphincter deficiency and in patients who had failed previous anti-incontinence procedures as a salvage procedure (1). While they are effective (2) and associated with a minimal risk of complication (2), the high cost of bone anchoring devices and reports of poor success (3) have likely contributed to the decreased usage of the BAS.…”

“…Success rates of BAS in the literature are extremely variable and range from 60.4 to 94% (2,3). Unfortunately, many previous studies report conglomerate results of different sling materials with bone anchors despite evidence that the biomechanical material properties, such as strength and host durability, differ substantially (4).…”