Non-mesh surgery for stress urinary incontinence TOG 2021

Question 1

3 main non-mesh surgical treatments for SUI

Answer 1

Colposuspension
Autologous fascial sling
Urethral bulking agents

Question 2

One person in a family (RCOG consent)

Answer 2

Very common
1/1-1/10

Question 3

One person on a street (RCOG consent)

Answer 3

Common
1/10-1/100

Question 4

One person in village

Answer 4

Uncommon
1/100 - 1/1000

Question 5

One person in a small town

Answer 5

1/1000-1/10,000

Question 6

One person in large town

Answer 6

> 1/10,000

Question 7

Most likely complication in any of the non mesh surgical treatmenta

Answer 7

Urine, vaginal or wound infection

Question 8

Describe Colposuspension

Answer 8

Attachingment of paravaginal fascia at level of bladder neck to iliopectinal (coopers) ligament

Question 9

Continence rates following Burch Colposuspension at 1 year and 5 years

Answer 9

1 year 85-90%
5 year 15-20%

No difference in outcomes Lap/Open

Question 10

How many sutures should be used in Colposuspension

Answer 10

Minimum 2 each side

Question 11

Recognised late complication of colposuspension

Answer 11

POP, enterocoele

Question 12

immediate complications of Colposuspension

Answer 12

25%
Bleeding - 2 %
Bladder injury (up to 9%)
Ureteric injury 2%
De novo occurrence overreactive bladder 3-8%
Dysparunia & pelvic pain 6%

Question 13

Significant difference outcome
- Autologous fascial sling (AFS)
- Porcine dermal graft
- Type-1 polyprolene mesh TVT

Answer 13

AFS and TVT similar outcome success 73-75%
Porcine lower 58%