Background: Female patients with refractory stress urinary incontinence (SUI) are a unique surgical challenge. They undergo multiple surgical procedures and eventually are left with urethral closure and continent diversion as their final option. We previously presented our initial experience of a technique that provides circumferential coaptation of the urethra in patients with severe urethral incompetence due to neurologic injuries or congenital anomalies. This study expands on that experience and reports on the clinical and quality of life following spiral sling in a defined population of patients with refractory SUI.
Methods: We prospectively evaluated 46 patients with refractory SUI who had a spiral sling. Surgical outcome was determined by clinical history, physical examination, and primarily by patient self-assessment and included validated symptom, bother, and quality of life questionnaires.
Results: Mean age was 62 years. Mean follow-up was 15 months. At presentation, patients had undergone a mean of 2.8 incontinence procedures and wore a mean of 5.5pads per day. Mean pad use decreased to 1.0 pads per day (P<0.05).Preoperatively the mean severity and bother score from SUI symptoms was 3.0 and 2.9, respectively (0=none, 3=severe). Postoperatively these numbers decreased to 0.9 and 0.7 (P<0.05). Mean overall improvement in symptoms was 84%. There were no perioperative complications. One patient failed the procedure and underwent urethral closure with urinary diversion. Two patients underwent a repeat proximal spiral sling.
Conclusions: The spiral sling is an effective salvage transvaginal procedure that may beconsidered for female patients with refractory SUI.