Outpatient Mid Urethral Tissue Fixation System Sling for Urodynamic Stress Urinary Incontinence: 1-Year Results

PurposeWe tested the feasibility of using the tissue fixation system to create a mid urethral sling for urodynamic stress urinary incontinence at a freestanding outpatient facility. The tissue fixation system is a new mini sling device with a 1-way tightening system.Materials and MethodsWe performed 44 mid urethral tissue fixation system sling operations between December 2006 and March 2008 at Yokohama Motomachi Women's Clinic LUNA. All patients had urodynamic stress urinary incontinence, as proven by preoperative urodynamics.ResultsMean ± SD patient age was 58.2 ± 11.9 years. Surgery was done on an outpatient basis using local anesthesia. Postoperative pain was minimal. All patients were discharged home the same day. Mean operative time, including local anesthesia administration, was 24.5 ± 7.7 minutes (median 25, range 15 to 50). Mean blood loss was 17.7 ± 21.7 ml (median 5, range 3 to 98). Five patients who could not pass urine within 8 hours were discharged home with an indwelling Foley catheter but they passed urine normally within 48 hours. The cure rate at 12 months was 90.9% (40 of 44 cases). Of the patients 15 (34.4%) had intrinsic sphincter deficiency. Three of the 4 failed cases were cured by another tissue fixation system mid urethral sling inserted at 6 months. There was no de novo urgency or urge urinary incontinence at 12 months.ConclusionsResults show that the tissue fixation system mid urethral sling operation is a simple, safe, effective procedure that may be done without difficulty at a freestanding clinic on an outpatient basis.