Transvaginal Bone Anchors in Female Stress Urinary Incontinence: Poor Results

Abstract

Objective: This study evaluates the results of a minimally invasive technique for correcting female stress urinary incontinence by transvaginal implantation of pubic bone anchors. Patients and Methods: Female stress urinary incontinence was treated by fixing a gelatin-coated Dacron sling between two miniature titanium anchors with Prolene sutures. Results: A total of 26 patients (median age 57.2 years) underwent the sling procedure. The follow-up examination was performed after 11.4 months on average. Stress incontinence showed a median improvement from grade 2 to grade 0.5 (p = 0.01), although only 16 of the 26 patients were completely continent. Urethral pressure and functional length were not significantly influenced. Impaired vaginal wound healing was seen in 14 of the 26 patients (53.8%), and 13 of them underwent revision. All patients affected (15/26, 57.7%) as well as 1 with uneventful healing showed sensory urge symptoms or detrusor instability (7/26, 26.9%). The correlation between impaired wound healing and detrusor instability was highly significant (p < 0.003). 17 of the 26 patients (65.3%) were dissatisfied or very dissatisfied with the intervention. The unfavorable results did not significantly correlate with the patients’ age, the number of previous operations, or the surgeon’s skill. Conclusion: In view of the poor vaginal wound healing and the resultant irritative symptoms, transvaginal bone anchoring with fixation of a Dacron sling must be regarded as an unsuitable technique.

Sling failures: What’s next?

“…In theory, this modification may reduce operating time and the morbidity of fascial harvest. Cure rates of 62% to 89% are reported in the short term, but an alarming 38% failure rate at 10.6 months also has been reported [11][12][13]. Bone anchor suspension of the sling does not appear to reduce the morbidity or complication associated with repeat SUI surgery.…”

Bone-anchored suburethral sling: Surgical technique and outcomes

“…More recent reports using solvent dehydrated cadaveric fascia BAS described a much lower failure rate with up to 60 months follow-up [22••]. Schostak et al [23] similarly reported poor outcomes using gelatin-coated Dacron BAS (Invista, Inc., Wichita, KS), with 65% of patients not satisfi ed after the procedure. They also reported mesh extrusion and de novo overactive bladder symptoms in 54% and 27% of patients, respectively.…”