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Day‐case sling surgery for stress urinary incontinence: feasibility and safety
Author(s) -
Giri Subhasis K.,
Drumm John,
Saunders Jean A.,
McDonald Jane,
Flood Hugh D.
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05410.x
Subject(s) - medicine , sling (weapon) , perioperative , surgery , visual analogue scale , urinary incontinence , prospective cohort study , urinary retention , complication , urinary system , catheter , cure rate , anesthesia
OBJECTIVE To prospectively assess the feasibility for discharge 10 h after a porcine dermal pubovaginal sling procedure (PVS), to examine the surgical factors (postoperative complications) affecting discharge, and to measure the short‐term cure rate for stress urinary incontinence (SUI). PATIENTS AND METHODS Between June 2003 and December 2003, 40 consecutive patients with SUI and scheduled for treatment using a porcine dermal sling were enrolled in this prospective study. Patients were admitted with a planned overnight stay and returned to the ward with no urinary catheter. Outcome measures were bladder emptying efficiency (EE) at 10 h after surgery, time intervals to the first three spontaneous voids, EE of the first three voids, time required to achieve an EE of ≥ 75%, a visual analogue scale pain score, perioperative complications, and short‐term cure rate of SUI. Patients were considered suitable for discharge from hospital when the EE was ≥ 75% or when they were self‐catheterizing confidently with adequate pain control and no significant complication. All patients were followed for 6 months. RESULTS The median EE at 10 h was 61%; 16 patients (40%) achieved efficient emptying and were suitable for discharge 10 h after surgery. The median intervals to the first three spontaneous voids were 7, 10 and 17 h, and the median EEs for the first three voids 46%, 61% and 75%. The median visual analogue scale pain score was 3.5. Patients with intrinsic sphincter deficiency (ISD) were significantly less likely to achieve efficient emptying at 10 h (39% vs 70%). Overall SUI was cured or improved in 90% of patients at the 6‐month follow‐up. CONCLUSIONS In the present study only 40% of patients were suitable for day‐case sling surgery. Early bladder emptying inefficiency was the main limiting factor. Exclusion of patients with ISD and possibly decreasing the EE threshold to 50% would improve the discharge rate. The short‐term results of this PVS are similar to those obtained with the autologous fascial sling.