Clinical outcome and changes in connective tissue metabolism after intravaginal slingplasty in stress incontinent women

Abstract

The intravaginal slingplasty procedure (IVS) was carried out on 75 patients with genuine stress urinary incontinence. The main aims of the operation are to create an artificial pubourethral ligament and to tighten the suburethral vaginal wall. An important ingredient in the supportive structures of the genitourinary region is fibrous connective tissue, consisting mainly of collagen. To analyse this component biopsies were obtained transvaginally, close to the position of the sling, both preoperatively and 2 years after surgery, from 6 patients. Collagen was analysed for concentration and extractability. Extractability by pepsin digestion was increased by 60% 2 years following surgery. Postoperative follow-up studies from 12 months to 3 years showed complete restoration of continence in 63 patients (84%) and considerable improvement in 4 others (5%). The 8 failures (9%) were all related to early rejection of the sling. The IVS procedure is an attractive surgical procedure as it necessitates minimum invasion and can be performed under local anesthesia, with a short hospital stay and sick-leave period. The enhanced collagen extractability indicates a changed metabolism, most likely induced by the implanted sling, resulting in a restoration of the elastic properties of the connective tissue.

Incidence of Overactive Bladder after Vaginal Hysterectomy and Associated Repairs for Pelvic Organ Prolapse

“…This could explain that women who undergo concurrent POP and SUI surgery are subjected to more damage, resulting in an increased incidence of de novo symptoms after surgery. It has also been pointed out that the occurrence of urge symptoms may be related to connective tissue reaction to the tape inserted during the TVT procedure [27] .…”

Cadaveric Fascia Lata versus Intravaginal Slingplasty for the Pubovaginal Sling: Surgical Outcome, Overall Success and Patient Satisfaction Rates

“…These data come from a limited number of centers and they report a cure rate ranging from 75 to 91% [8][9][10][11] . In our study, the low cure rate of the IVS procedure could be due to the insufficient tissue reaction of the polypropylene implant (70.8%).…”

Computerised morphometric study of the paraurethral tissue in young and elderly women

“…In this context, changes in connective tissue properties have been associated with stress urinary incontinence [Ulmsten et al, 1987;Falconer et al, 1994;Keane et al, 1997]. Detailed information about structure and distribution of connective tissue is also of relevance for developing new surgical techniques [Falconer et al, 1996a]. Research on the pelvic £oor has been done, amongst other, by gross-anatomical [Zacharin, 1963], histological [Wilson et al, 1983;DeLancey, 1990], ultrastructural [Falconer, 1998], and biochemical [Falconer et al, 1994[Falconer et al, , 1996b investigations.…”