V2-04: Rectus fascia spiral sling (RFSS) technique for women with multiple failed stress incontinence surgery due to severe intrinsic sphincteric deficiency
VideoIntroductions and Objectives
Severe intrinsic sphincter deficiency (ISD) is a common cause of failed stress urinary incontinence (SUI) surgery. Management of women with multiple failed surgeries is particularly challenging, and these women are candidates for artificial sphincter implantation or continent urinary diversion. We present our experience with rectus fascia spiral sling (RFSS) in women with treatment-refractory ISD.
Four women (age: 19-64) underwent RFSS between 2011-2014. All women had severe incontinence with minimal activity or a slight change in body position. All had undergone multiple (range: 2-5) surgeries for SUI. Clinical evaluation included subjective assessment with ICIQ-SF questionnaire, pelvic physical examination, and urodynamic studies. All patients demonstrated marked ISD with a valsalva leak point pressure
Bladder neck was entered in one patient during retropubic dissection. RFSS was completed without any consequence after primary repair. One patient received concomitant ileocystoplasty due to small-capacity (ie. 100 cc) bladder. No women developed urinary retention or voiding dysfunction necessitating intermittent catheterization.With a mean follow-up of 10 months (range: 3-24), SUI was cured in 2 (0-1 pad/day) and significantly improved in 2 women. Mean number of pads/day decreased from 6.25 preoperatively to 1.25 postoperatively (p=0.03). Mean ICIQ-SF score decreased from 18.75±1.5 preoperatively to 6.5±2.5 postoperatively (p=0.01, Wilcoxon signed-rank test).
RFSS is an effective option in women with treatment-refractory ISD, which may be considered before proceeding to more invasive treatment modalities.