Tension-Releasing Appendage Suture-Loop for Adjustable Single-incision Sling Devices for Postoperative Voiding Dysfunction: A Simple Technique to Relieve Excessive Sling Tension.

Abstract

Study objective: To assess voiding dysfunction (VD) and restoration of normal voiding due to sling over-tension following tension-releasing suture-loop (TRS-loop) manipulation. Second, to evaluate cure rates, complications, and Quality of Life at 1-year post-operatively.

Design: Retrospective study SETTING: Tertiary hospital in Taiwan PARTICIPANTS: Patients who underwent I-stop mini-procedures between March 2019 and January 2024 INTERVENTIONS: Patients with stress urinary incontinence (SUI/USI) who underwent I-stop-mini procedure were included. To improve voiding function in post-operative patients with urinary retention, TRS-loop manipulation was performed by pulling the appendagesuture-loop and adjusting the sling tension. Objective assessments included PVR measurement, urodynamic studies, and a 1-hour pad test. Subjective assessments included the Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6). Follow-ups were performed at 1 week, 1 month, 3 months, 6 months, and 1-year.

Results: Objective and subjective cure rates were 91.3% and 89.6%, respectively. Ten patients required TRS-loop manipulation and one required a repeat adjustment. TRS-loop manipulation had a mean VAS score of 1.20, with an objective cure rate of 100% and subjective cure rate of 90%. Urodynamic improvements were observed in both groups, however, the differences were not statistically significant.

Conclusion: TRS-loop manipulation is an effective method for addressing post-operative VD due to excessive sling tension without the need for additional invasive interventions. The high cure rates and improvements in QoL suggest their importance in SUI management. However, further research is needed to confirm the long-term outcomes.