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Trocar-assisted sling suspension for stress urinary incontinence: three-year follow-up
Chyi-Long Lee1, Chih-Feng Yen, Chin-Jung Wang
1Division of Gynecologic Endoscopy, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsin Street, Kwei-Shan, Tao-Yuan, Taiwan.
Study Objective:
To evaluate 3-year outcomes of trocar-assisted sling suspension (TASS) for genuine stress incontinence.
Design:
Retrospective review (Canadian Task Force classification II-2).
Setting:
University-based, tertiary-level center for endoscopic surgery.
Patients:
One hundred forty women with genuine stress incontinence with bladder neck hypermobility.
Intervention:
After standard surgery preparation and general endotracheal anesthesia, TASS was performed. The periurethral space and thicker parts of the pubocervical fascia were opened from the vagina. A 0.5-cm incision was made on both sides of the lower abdomen and was measured 4-cm lateral to the linea album and 2-3-cm above the pubic bone. A trocar was used to penetrate the incision site to the space of Retzius. A 2-cm x 30-cm folded polypropylene mesh was placed inside the vagina and was then pulled out of the trocar sheath by a laparoscopic forceps.
Measurements And Main Results:
All patients completed the procedures without exception. The average blood loss was less than 50 mL (range 10-200 mL). The operative time ranged from 20 to 90 minutes with a mean time of 32 +/- 12 minutes. Eleven patients had voiding difficulty. Six of them voided well after intermittent self-catheterization performed 28 days postoperatively. Seven patients had poor healing of the anterior vaginal wall; therefore, removal of mesh and wound repair were performed. One patient suffered from a retroperitoneal hematoma, and one patient had an intraoperative bladder injury. The overall complication rate was 14.3%. During 12-36 months of follow-up, 134 of 140 patients (95.7%) were satisfied with the surgery.
Conclusions:
Based on the results of our pilot study, TASS is quite feasible as a method of treatment for stress urinary incontinence. The surgery is not difficult to perform when compared with Burch colposuspension. Moreover, it encompasses the simplicity and effectiveness of tension-free vaginal tape surgery. In addition, TASS also can correct lateral wall defects such as cystocele.
