Double forced sling by combining in situ vaginal wall and Infast pubic bone suburethral stabilization techniques: a new method.

摘要

PURPOSE: We evaluated the results and effectiveness of the double forced sling by combining in situ vaginal wall and Infast (Influence, Inc., San Francisco, California) pubic bone suburethral stabilization techniques as a new method. MATERIALS AND METHODS: The new technique was used in 40 patients, of whom 32 completed 2 years of followup. Previous surgery included hysterectomy in 8 cases, anterior and posterior vaginal wall repair in 6, and 1 or 2 incontinence procedures in 24. Types 2, 3 and mixed incontinence were diagnosed in 12, 12 and 8 patients, respectively. With this technique a gelatin coated synthetic sling was fixed to the previously prepared vaginal sling surface with watertight stitches to create a doubled forced sling, which was fixed to the pubic bone with 2 screws using an Infast inserter. Patient outcomes were evaluated by questionnaire analysis and the pad test. RESULTS: The cure, improvement and failure rates were 81.25%, 6.25% and 12.5% in the 32 patients who completed 2 years of followup. Surprisingly successful results were achieved in all 24 secondary cases. Moderate cystocele in 4 patients and rectocele in 8 were corrected simultaneously. Temporary urinary retention in 4 patients resolved in 2 weeks. Of the 32 patients 28 reported that they would repeat the procedure and recommend it to others. CONCLUSIONS: The double forced sling has 2 advantages that make it superior to other techniques, namely a minimal complication rate and enhanced support accomplished by an easy and noninvasive technique.