[Stress urinary incontinence surgery with MiniArc swing system: our experience]

To describe the surgical technique of AMS MiniArc swing system for the treatment of female urinary incontinence, evaluate its results and complications.

We performed a retrospective study of surgery with AMS Miniarc swing system. From august 2007 to march 2009, 135 patients with urinary incontinence (UI) underwent AMS MiniArc swing system surgery in hammock way. 110 patients (81.5%) suffered from stress urinary incontinence (SUI) and 25 (18.5) from mixed (MUI). The average age was 55 years-old. All these procedures were performed wigh local anesthesia and in <>. We evaluate every patient a month later, between 3-6 months later, and a year after surgery. During the following up, clinical history was made in every women with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress test with full bladder. We use the SPSS program (V 14.0) for statistical analysis of the results (Student's t-test).

With a mean follow-up of 495 days (range from 181 to 777), early complications included: 2 bladder perforations during sling placement, inguinal pain in 4 patients and one obturator hematoma (resolved spontaneously). The long-term postoperative complications were: 4 tape exposures in vagina (2.9%), urethral obstruction in 3 patients (2.2%) that required urethrolysis and net section, and irritative symptoms of frequency and urgency reported in 9 patients (6.6%), 5 out of 9 were temporary (between 2 and 6 months) whereas the remaining 4 required anticholinergic agents due to persistent symptoms. When evaluating the success rates of anti-incontinence surgery, 91.9% of patients showed objective cure (88% with MUI and 92.7% with SUI) since we demonstrated no loss of urine by physical examination with full bladder. The ICIQ-SF score (fourth question included) decreased an average of 12.7 points. 90% of patients were very or fairly satisfied.

The AMS Minarc swing system is an optim anti-incontinence procedure. Its main advantage might be the possibility of performing this procedure under local anesthesia, in order to test and adjust the sling's tension according to the person's needs. Despite its promising results, further studies are required in order to arrive at more precise conclusions, taking into account that the TVT remains the gold standard surgical technique of SUI.