NEW YORK (Reuters Health) – A couple of extra sutures makes a difference to the clinical efficacy of a mid-urethral sling procedure for treating female stress urinary incontinence, a Polish team reports in the Journal of Urology for July.

Dr. Konrad Futyma and colleagues at the Medical University of Lublin note that placement of a mid-urethral sling has a high success rate (up to 95%) in curing stress urinary incontinence. Some failures, they explain, may be due to improper tape position, since “tape placement under the mid urethra seems to be essential for a favorable outcome regardless of the type of operation (retropubic or transobturator).”

To see if additional fixation of the tape to prevent displacement during tensioning could improve outcomes, the group randomly allocated 463 women with stress urinary incontinence to a standard transobturator intravaginal monofilament sling procedure or to the same procedure with an additional two sutures parallel to the urethra to fix the tape in place.

Based on a cough test and 1-hour pad test at 12 months, rates of cure or improvement were 88.73% in the standard group and 95.12% in the fixation group (p=0.0169), the investigators report

The benefit was particularly apparent in a subgroup of patients with poor sphincter function, according to the report. Specifically, 31 of 42 (73.8%) such women in the control group were cured or improved compared to 39 of 41 (95.1%) women in the fixation arm (p=0.0011).

There were no serious complications during surgery in either group, the authors report. Intraoperative bladder injury occurred in four women in the control group and three in the fixation group – all of which were repaired without sequelae.

“In conclusion,” Dr. Futyma and colleagues write, “tape fixation is a simple surgical maneuver that seems to improve transobturator sling effectiveness, especially in patients with ISD (intrinsic sphincter deficiency), and does not markedly increase procedure duration or cost.”

Reference:
Tape Fixation: An Important Surgical Step to Improve Success Rate of Anti-Incontinence Surgery
J Urol 2011;186:180-184.