[Subtrigonal sling with abdominal fascia for treatment of complex stress urinary incontinence]

The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI).

We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI).

Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively.

Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity.