The effectiveness of sling using in treating of stress incontinence in women. The results of 28 operations

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The aim. Analsis of effectiveness in use of sling in incontinence treating in women.

Material and methods. The department of urology in Rostov State Medical University has the experience in using of sling in 28 (100%) patients from 40 to 63 years old. Previously 20 (71,4%) patients had complicated deliveries. 16 (57,1%) pts had perineal tears during deliveries, 3 (10,7%) pts had delivered large babies. And 1 (3,6%) patient had the late termination of pregnancy. Duration of disease in 6 (21,4%) pts was from 1 to 3 years, in 12 (42,8%) - from 1 to 3 years from 4 to 7 years, in 10 (35,7%) - more than 10 yrs. Previously 22 (78,6%) pts were treated conservatively without effect. According to classification of Mc.Guirr 6 (21,4%) pts had 2a type incontinence, 18 (64,3%) had 2b type incontinence, 3 (10,7%) pts had 3a type. 17 (60,7%) pts had cystocoele. And 3 (10,7%) had rectocoele.

Operation. In anterior wall of vagina there were placed two semicircular sutures with prolene formed the circumference of 5cm diameter. Leaving 5mm from the line of suture we cut the wall of vagina, lateral sides of wound was mobilized on 2.5cm from each side. Leaving the urethra on right and left side we made canals to retropubic area. Needle-perforator one by one was led through the canal from two incisions made above to the both sides of pubis and was taken out through the vaginal wound. With the help of perforator suture was placed in the canal in retropubic area. To confirm that no perforation of bladder was made the ureterocystoscopy was done. If it was needed the plastics of cystocoele was made with the help of pubocervical ligaments and posterior wall of bladder. Lateral layer of vaginal wound was ligated by vicryl N-3-0. Thus we inserted the remaining layer of the wound into itself. The sutures were togethered by making an additional cut at the center and through which they were inserted and were ligated together with a special modified fixator. By this way there were no periphereal contacts of sutures. Sutures were fixed above aponeurosis.

Results. In 20 (71,4%) pts in postoperative period we corrected the pulling of sutures for obtaining of maximal results. In 22 (78,6%) pts symptoms of incontinense absolutely disappeared. In 4 (14,3%) - symptoms redused significantly. Transvaginal ultrasonography and vaginal exam of all patients didn’t revealed any rough scarring defects in postoperated area. The follow up of patients was 2 years. Complete rehabilitation was attained in 21 (75%) pts, in 5 (17,9%) pts incontinence decreased, in 2 (7,14%) pts incontinence after operation didn’t reduced. Postoperative complications: blockage of urine and need in catheterization were marked in 4 (14,3%) pts, activation of urinary infection was found in 7 (25%) pts. Pain in pubic area - in 10 (35,7%) pts In one patient (3,6%) there was the replace of incontinence due to straining exercise. Examined her we found the break of pubovaginal sutures.

Conclusion. Turndown from mobilization of anterior wall of vagina minimized the danger of development of dystrophic and scarring changes in vesico-urethral segments. The given method helps to form new anatomo-physiologic understanding between proximal urethra and pelvic diaphragma in short-term.

About the authors

A. G. Ivanov

Rostov State Medical University

Author for correspondence.
Email: info@eco-vector.com

Department of Urology

Russian Federation, Rostov on Don

V. V. Krasulin

Rostov State Medical University

Email: info@eco-vector.com

Department of Urology

Russian Federation, Rostov on Don

Y. V. Terentev

Rostov State Medical University

Email: info@eco-vector.com

Department of Urology

Russian Federation, Rostov on Don

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