The polypropylene pubovaginal sling for the treatment of recurrent stress urinary incontinence.

Abstract

The significance of a 2-team approach to the problems of recurrent incontinence in patients with extensive pelvic scarring from previous surgery is emphasized. We reviewed 88 consecutive patients who presented between January 1986 and November 1992. The demonstration of a scarred, wide open, proximal urethra or drain pipe urethra was the important selection criterion. Two teams, 1 operating abdominally and 1 vaginally, released the bladder neck from its bed of scar under direct vision and set the sling in place with minimal tension at the bladder neck. Of the women 75 (85.2%) were cured of the stress urinary incontinence and 8 (9.1%) had improvement with mainly urge incontinence, while 5 (5.7%) operations failed. There was a significant association between chronic chest disease and failure. The 2-team polypropylene (Marlex) mesh approach continues to be an effective treatment for women with complicated stress urinary incontinence.