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THE JOURNAL OF FEMALE
URINARY INCONTINENCE

Commented Abstracts

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  • Complications of silicone "sling" insertion for stress urinary incontinence.
    Duckett J.R., Constantine G.
    Department of Obstetrics and Gynaecology, Good Hope Hospital, Sutton Coldfield, West Midlands, United Kingdom.

ABSTRACT

PURPOSE: A pilot study was performed to evaluate the suitability of silicone as a substance for suburethral sling placement. Using rectus sheath for sling placement can be time-consuming and can result in increased morbidity. Adjustable synthetic materials of consistent strength are available. Silicone has previously been used successfully and was chosen for this trial.

MATERIALS AND METHODS: Slings were inserted in 7 women with stress urinary incontinence. Of the patients 3 had a history of continence surgery and presented with reduced vaginal mobility, and 2 who had not previously undergone continence surgery had intrinsic sphincter deficiency.

RESULTS: In all women stress urinary incontinence was subjectively cured. However, after 7 slings were inserted the study was terminated due to a high complication rate related to erosion and sinus formation in 5 slings which were removed. Complications developed immediately or up to 11 months after sling insertion. Continence was maintained in 4 of the 5 women after the slings were removed.

CONCLUSIONS: Silicone is an inappropriate material for suburethral sling placement when used as described in our cases, caution should be exercised when placing silicone slings at this site.


EDITORIAL COMMENT

The main objectives of Ducket and Constantine were to find a synthetic material that allowed to avoid the inconveniences of the sling of fascia aponeurose (I increase of the surgical time, persistent pain in the postoperative period, fall of the long term efficiency) as well as of the synthetic materials commonly used (erosion, extrusion, infection and difficulties surgical case had need of retreat of the " sling "). The silicon, for its biophysical characteristics, would be an attractive theoretical option for being relatively inert. The authors ended that, in the practice, the persistence of the sling of silicon without incorporation to the adjacent fabrics, determined indexes of unacceptable complications, with need of removal of the sling in 71% of the patients and they considered the inappropriate material for the use in the sling procedure.

Aparecido Donizeti Agostinho

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