Surgical treatment of female stress incontinence: impact of changed views on polypropylene

The introduction of the tensionfree vaginal tape in 1995 drastically changed the landscape of surgical procedures for stress urinary incontinence (SUI). Because of the uncomplicated technique many urologists and gynecologists embraced the procedure with tripled the number of annual procedures in the beginning of this century. At the same time polypropylene was used for the development of surgical procedures of pelvic organ prolapse (POP). Especially the use of polypropylene for POP has caused many severe clinical complications. This caused a huge reduction of these kind of surgical procedures and it is performed nowadays only under strict conditions. At the same time the use of polypropylene for SUI was scrutinized and questioned. Nowadays, in the Ango-Saxon countries the use of polypropylene tapes for SUI is not recommended. This manuscript explores the role of polypropylene tapes for SUI. Questions that are dealt with are: How dangerous are polypropylene tapes anyway? What are the alternatives? Which factors contribute to a successful outcome of stress incontinence surgery?

Late urological manifestation of stress incontinence surgery

The Stamey procedure was a popular procedure for female stress incontinence practiced widely in the 1980s before it was abandoned owing to high complication rates. The procedure aimed to suspend the bladder neck by placing two transvaginal Dacron buttress grafts either side of the bladder neck and suspending them with sutures passed through the retropubic space and tied suprapubically. Erosion of the graft into the bladder was a recognised complication. We report a case of an 84-year-old lady who presented with urinary symptoms forty years after an unspecified stress incontinence procedure. Imaging and cystoscopy revealed an eroded graft in her bladder wall. Further investigation revealed the graft was a Dacron buttress from a Stamey procedure. This case highlights the importance of having a working knowledge of historical techniques that may present with complications many years later and recognising the symptoms that should prompt early investigation.

The use of polyacrylamide hydrogel in the setting of failed female stress incontinence surgery

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