Abstract
The intravaginal slingplasty procedure (IVS) was carried out on 75 patients with genuine stress urinary incontinence. The main aims of the operation are to create an artificial pubourethral ligament and to tighten the suburethral vaginal wall. An important ingredient in the supportive structures of the genitourinary region is fibrous connective tissue, consisting mainly of collagen. To analyse thi component biopsies were obtained transvaginally, close to the position of the sling, both preoperatively and 2 years after surgery, from 6 patients. Collagen was analysed for concentration and extractability. Extractability by pepsin digestion was increased by 60% 2 years following surgery. Postoperative follow-up studies from 12 months to 3 years showed complete restoration of continence in 63 patients (84%) and considerable improvement in 4 others (5%). The 8 failures (9%) were all related to early rejection of the sling. The IVS procedure is an attractive surgical procedure as it necessitates minimum invasion and can be performed under local anesthesia, with a short hospital stay and sick-leave period. The enhanced collagen extractability indicates a changed metabolism, most likely induced by the implanted sling, resulting in a restoration of the elastic properties of the connective tissue.
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Editorial comment: This paper addresses two aspects of the newly described minimally invasive ‘slingplasty’ procedure for stress incontinence: the success of the procedure and its effect on collagen metabolism in the area of the surgery. With a reported success rate of 89%, the slingplasty compares favorably to other incontinence procedures. Unfortunately, postoperative urodynamic evaluation with repeat cystometrogram and urethral pressure profilometry was not performed; the success of the procedure was evaluated by standardized questionnaire, subjective grading of leakage on a visual analogue scale, 48-hour urolog, 24-hour pad test and cough stress test with a full bladder. Multichannel studies would be of interest to clarify the effect of the slingplasty and proposed change in collagen metabolism on urethral pressure measurements. It would also be interesting to visualize the anatomic and functional results of the surgery by either ultrasound, voiding cystometrogram or videourodynamics. The other goal of the study was to assess the effect of the procedure on collagen in the periurethral area. Although the finding of increased collagen turnover is thought-provoking, the lack of samples obtained and the confounding effect of a simultaneously performed anterior repair limits the conclusions that can be made.
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Falconer, C., Ekman-Ordeberg, G., Malmström, A. et al. Clinical outcome and changes in connective tissue metabolism after intravaginal slingplasty in stress incontinent women. Int Urogynecol J 7, 133–137 (1996). https://doi.org/10.1007/BF01894201
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DOI: https://doi.org/10.1007/BF01894201