Polytetrafluoroethylene sling for failure in female stress incontinence surgery

Surgery for stress urinary incontinence (SUI) in women with previous interventions is often difficult and yields poor results. A total of 33 women with recurrent SUI underwent placement of a polytetrafluoroethylene (PTFE) sling after a mean of 1.5 (range, 1-3) unsuccessful operations. Preoperative bladder instability (BI) was ruled out in all cases. The patients' mean age was 54 (range, 34-79) years. In all, 64% had SUI and 36% had SUI and incontinence at rest. The Aldrige-Stoeckel technique is used with insertion of a 2 x 30 cm sling instead of fascia lata. Mean operating time was reduced in 40 minutes. After a mean follow-up period of 13 months, 72% of the patients achieved continence without retention (complete success). Altogether, 16 patients (48%) required self-catheterization after discharge, with the voiding imbalance lasting for more than 3 months in only 4 cases (12% of the total). Three patients underwent surgery for outlet obstruction. There were five abdominal wound infections but no vaginal wound infection. Two slings have since been removed (one partially), but none has eroded through the urethra. The PTFE sling is a reasonable option for this group of patients. Retention is usually self-limited, and most complications can be managed successfully.