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.

A Randomized Trial of Urodynamic Testing Before Stress Incontinence Surgery

This chapter summarizes the results of the VALUE trial, in which women with stress urinary incontinence scheduled to undergo incontinence surgery were randomized to undergo preoperative urodynamic testing versus office evaluation alone. Treatment was considered successful in a similar, large proportion of women in both groups. A diagnosis of stress urinary incontinence was confirmed in most of the women who underwent urodynamic testing; changes were made to their surgical planning on the basis of the additional testing in very few of them. These findings suggested that urodynamic testing may not contribute to the overall success rate of surgery in healthy women with uncomplicated stress urinary incontinence.

Preoperative Urodynamics Testing in Stress Urinary Incontinence

This article outlines the scientific methods, results, and conclusions for the ValUE trial, “A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery.” The ValUE trial compared patients with stress urinary incontinence (SUI) who underwent office evaluation with or without preoperative urodynamics (UDS) testing prior to an anti-incontinence procedure. The majority of patients in the study underwent a mid-urethral sling. The study showed no difference in surgical or treatment outcomes for patients with uncomplicated SUI, signifying UDS may not be necessary in preoperative evaluation. Patient characteristics of uncomplicated SUI are discussed for translation into clinical practice. Reviews of related articles with secondary data analysis are summarized.