Vol. 44 (3): 543-549, May – June, 2018
Danilo Budib Lourenço 1, Fernando Korkes 1, José Eduardo Vetorazzo Filho 2, Silvia da Silva Carramão 3, Antônio Pedro Flores Auge 3, Luis Gustavo Morato de Toledo 2
1 Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Departamento de Urologia; 3 Departamento de Ginecologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings.
Data from 57 women who underwent consecutive TO sling surgery to treat SUI were prospectively collected between 2012 and 2014, and divided in two groups for further comparison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test.
Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All demographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.
Keywords: Urinary Incontinence, Stress; Pelvic Floor; Suburethral Slings