To assess the outcomes results of the 6-point fixation and weight-adjusted spacing nomogram for performing sling surgery without causing urethral obstruction.

 

Methods.

Between July 1997 and April 1999, 50 women with stress incontinence underwent implantation of Gore-tex sling. Preoperative evaluation included urodynamics, cystoscopy, Q-tip test, and cough stress test. The intraoperative sling tension was gauged using the 6-point fixation technique and weight-adjusted spacing nomogram based on the patient’s ideal body weight.   Postoperatively, an outcomes analysis was performed using cough stress test, Q-tip test, pelvic examination and validated patient satisfaction questionnaires.   Urodynamic studies were performed for women with persistent urinary incontinence.  

 

Results.

The mean follow-up was 24 months (range 7-28).  The mean age was 58 years (range 29-87).  Stress incontinence was objectively cured in 47/50 patients (94.0%) and subjectively cured in 49/50 (98%).   The mean pad use decreased from 3.2 pads/day to 0.5 pads/day.   Transient de novo urge incontinence was experienced by 1/23 (4.3%) patients.   Preoperative mean resting and Valsalva Q-tip angle was 0º (range 0 to 5) and 65º (range 0 to 85).   Postoperative mean resting and Valsalva Q-tip angle was 0º (range –5 to 5) and 15º (range 0 to 25).   The mean time to suprapubic tube removal was 7 days (range 1-21).   No patients experienced urinary retention or urethral obstruction.   The mean satisfaction score was 9/10 (range 7-10).   Of the group, all (50/50) replied they would undergo surgery again.

 

Conclusions.

The use of the 6-point fixation technique and the weight-adjusted spacing nomogram is simple and easy to reproduce.   Proper combination of these two techniques allow for a successful sling outcome without urethral obstruction.