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Abstract
Objective: Determination of the short term safety, efficacy and urodynamic effect of the use of
Prolene mesh as a midurethral sling for surgical correction of female stress urinary
incontinence using trans-obturator vaginal tape inside -out technique as a low cost alternative
for available commercial kits in the treatment of female stress urinary incontinence.
Patients and Methods: Since June 2006, thirty female patients with stress urinary
incontinence (9 with pure ISD (30%), 18 with urethral hypermobility (60%) & 3 (10%) with
combined ISD & hypermobility) underwent Prolene mesh midurethral sling in our institution.
Preoperative evaluation consisted of history, examination, ultrasonography, ascending
cystography, urodynamic studies, and routine labo ratory investigations. SUI was evident
clinically in all patients. 2 patients underwent anterior colporrhaphy concomitant to the Prolene
mesh procedure for correction of symptomatic grade II cystocele. Prolene mesh was cut into a
tapes measuring 10x1.5 cm and sterilized by autoclave. The mesh was placed at the mid -
urethra and passed through the obturator foramen a by Prolene sutures loaded on specially
designed helical passers. The helical passers were passed inside -out. The prolene sutures were
anchored to the subcutaneous tissue at the site of exit. Patients were followed up (for a mean of
9 months) by history, examination, urine analysis, pelvic ultrasound to detect residual urine,
and urodynamic evaluation at 1, 3, 6, 9 & 12 months post-operatively.
Results: All procedures were completed with no intraoperative complications, no failures or
recurrences of stress incontinence. All patients were objectively cured but twenty nine patients
were subjectively cured (96.7%). One patient (3.3%) developed obstruction but she could
complete her voiding without residual urine . She was satisfied with her results. 3 patients
(10%) developed vaginal infection, one patient (3.3%) developed wound infection, two
patients (6.7%) developed UTI & one patient complained from dy spareunia. Lower limb &
groin pain has been developed in 15 patients (50%), but was controlled by analgesics and has
disappeared in all patients within the 1st post-operative month. Subcutaneous non absorbable
sutures were felt in one patient. De novo urgency and erosions have not occurred in any
patient.
Conclusion: Results of our technique showed that midurethral trans-obturator prolene mesh
sling is safe, efficient, reproducible and a low cost technique for treatment of stress urinary
incontinence. Our technique does not require disposable instrumentation for placement, and is
inexpensive as our modified helical passers have the advantage of being resterilizable & each
Prolene strip will cost less than 10 EGP. The price of similar incontinence kits in the market
ranges from (3000 − 3500 EGP) per set. Long term follow up is required together with
prospective randomized studies with the original TVT -O technique to confirm these results.