Trocar-Assisted Sling Suspension for Stress Urinary Incontinence: Three-Year Follow-up

Study Objective

To evaluate 3-year outcomes of trocar-assisted sling suspension (TASS) for genuine stress incontinence.

Design

Retrospective review (Canadian Task Force classification II-2).

Setting

University-based, tertiary-level center for endoscopic surgery.

Patients

One hundred forty women with genuine stress incontinence with bladder neck hypermobility.

Intervention

After standard surgery preparation and general endotracheal anesthesia, TASS was performed. The periurethral space and thicker parts of the pubocervical fascia were opened from the vagina. A 0.5-cm incision was made on both sides of the lower abdomen and was measured 4-cm lateral to the linea album and 2–3-cm above the pubic bone. A trocar was used to penetrate the incision site to the space of Retzius. A 2-cm × 30-cm folded polypropylene mesh was placed inside the vagina and was then pulled out of the trocar sheath by a laparoscopic forceps.

Measurements and Main Results

All patients completed the procedures without exception. The average blood loss was less than 50 mL (range 10–200 mL). The operative time ranged from 20 to 90 minutes with a mean time of 32 ± 12 minutes. Eleven patients had voiding difficulty. Six of them voided well after intermittent self-catheterization performed 28 days postoperatively. Seven patients had poor healing of the anterior vaginal wall; therefore, removal of mesh and wound repair were performed. One patient suffered from a retroperitoneal hematoma, and one patient had an intraoperative bladder injury. The overall complication rate was 14.3%. During 12–36 months of follow-up, 134 of 140 patients (95.7%) were satisfied with the surgery.

Conclusions

Based on the results of our pilot study, TASS is quite feasible as a method of treatment for stress urinary incontinence. The surgery is not difficult to perform when compared with Burch colposuspension. Moreover, it encompasses the simplicity and effectiveness of tension-free vaginal tape surgery. In addition, TASS also can correct lateral wall defects such as cystocele.