Polytetrafluoroethylene sling for failure in female stress incontinence surgery

Abstract

Surgery for stress urinary incontinence (SUI) in women with previous interventions is often difficult and yields poor results. A total of 33 women with recurrent SUI underwent placement of a polytetrafluoroethylene (PTFE) sling after a mean of 1.5 (range, 1-3) unsuccessful operations. Preoperative bladder instability (BI) was ruled out in all cases. The patients' mean age was 54 (range, 34-79) years. In all, 64% had SUI and 36% had SUI and incontinence at rest. The Aldrige-Stoeckel technique is used with insertion of a 2 x 30 c m sling instead of fascia lata. M e a n operating time was r e d u c e d in 40 minutes. After a mean follow-up period of 13 months, 72% of the patients achieved continence without retention (complete success). Altogether, 16 patients (48%) required self-catheterization after discharge, with the voiding imbalance lasting for more than 3 months in only 4 cases (12% of the total). Three patients underwent surgery for outlet obstruction. There were five abdominal wound infections but no vaginal wound infection. Two slings have since been removed (one partially), but none has eroded through the urethra. The P T F E sling is a reasonable option for this group of patients. Retention is usually selflimited, and most complications can be managed successfully.The pubovaginal sling procedure as an intervention for stress urinary incontinence (SUI) was described initially by Goebel in 1910 [5] and by Stoeckel in 1917 [12]. A modification of the technique using fascia lata and the pyramidal muscle was introduced by Aldridge in 1942 [ 1]. Since then, multiple technical variations and different materials have been described [4, 7, 10, 11, 14]. We report our experience with the first 33 patients presenting with recurrent SUI after undergoing other surgical procedures in w h o m a polytetrafluoroethylene (PTFE) sling was placed.

Do preoperative cytokine levels offer a prognostic factor for polypropylene mesh erosion after suburethral sling surgery for stress urinary incontinence?

“…The reported incidence of sling material erosion used during pubovaginal sling placement is 0.3% to 23% and autologous material has the lowest rate [13]. For expanded polytetrafluoroethylene slings, rejection rates of 6-32% have been reported [14,15]. A similar rejection rate has been reported for polyethylene slings [16].…”

Expanded PTFE bladder neck slings for incontinence in children: the long‐term outcome

“…The use of Gore-tex slings has been well described in adult women with stress urinary incontinence [11][12][13]. The main complications reported include temporary urinary retention needing CIC, urge incontinence, and less commonly erosion into the urethra.…”

“…The main complications reported include temporary urinary retention needing CIC, urge incontinence, and less commonly erosion into the urethra. Short-to moderate-term followup has yielded high continence rates [11][12][13]. A Cochrane database review found the Goretex sling to have a higher complication rate than fascial slings for urinary incontinence in women in a small series of patients [14].…”

Safety considerations for synthetic sling surgery

“…151 Other more serious infections have been reported after SMUS implantation. In a comprehensive literature review 45 several such complications following sling placement were reported: cellulitis; [117][118][119][120][121]187 abscess formation, including in the retropubic space, 122 retroperitoneal space, 123 thigh, 123 obturator space [124][125][126] and ischiorectal fossa; 127,128 sinus tract formation; 129 necrotizing fa sciitis; 130 osteitis pubis; 131 and sepsis. 12 Thigh abscesses, a complication unique to the TOT sling approach, have been reported in the past decade.…”

“…In addition, we estimate that bowel perforation and serious infections have a combined incidence of about 0.1%. [117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133][134] Refractory and potentially lifestyle-altering complications include chronic pain (4.1%) and de novo overactive bladder (OAB) in 11% (Table 5), although the number of patients with de novo OAB who are refractory to treatment remains unknown. Evidence suggests that well over 50% of patients with OAB of any aetiology discontinue medical treatment within 1 year, owing to a combination of poor effectiveness and low tolerability.…”