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Laparoscopic two-team slings for women with stress urinary incontinence
Rose C Kung1, Grace Liu, Patricia E Lee
1Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
Study Objective:
To review long-term success and complication rates of laparoscopic two-team sling procedures in women with stress urinary incontinence or mixed incontinence confirmed by urodynamic testing and cystoscopy.
Design:
Prospective study (Canadian Task Force classification II-2).
Setting:
Tertiary urogynecology unit at a university-affiliated teaching hospital.
Patients:
One hundred seventy-five women.
Interventions:
Laparoscopic two-team sling procedure.
Measurements And Main Results:
The extraperitoneal approach to the space of Retzius was accomplished using a balloon device, and the intraperitoneal approach involved a transverse incision through the anterior parietal peritoneum 6 cm above the symphysis. A 1.5- to 2.0-cm wide strip of polypropylene mesh was inserted through a vertical incision along the anterior vaginal wall, perforating the urogenital diaphragm under laparoscopic guidance. The mesh was sutured to Cooper's ligaments bilaterally with 0 polypropylene sutures. Mean operating time was 80.1 +/- 30.0 minutes, mean estimated blood loss was 160 +/- 146 ml, and mean hospital stay was 2.4 +/- 1.2 days. Patients were followed at 6 weeks, 6 months, 1 year, and yearly (mean 17.8 mo, range 1-5 yrs).
Conclusion:
Laparoscopic two-team sling procedures can be performed safely in women with recurrent stress incontinence and those with risk factors for failure of retropubic urethropexy. Long-term success rates are excellent (91.1%) with few complications.
