The Intravaginal Slingplasty Operation, a Minimally Invasive Technique for Cure of Urinary Incontinence in the Female
Authors: Petros Pe Papa 
Published: February 2008

EDITORIAL COMMENT: All readers surely believe that everyone with a new idea has a right to be heard although in the case of a journal this means passing scrutiny of the referees. In obstetrics the curse of all clinicians is prematurity. In gynaecology it is urinary incontinence. Stress incontinence is the urogynaecologist's delight with a specific diagnosis and a range of special procedures for its surgical treatment with high prospects of lasting cure. The enigma is detrus or instability and other forms of incontinence where there is no prolapse or evidence of stress incontinence clinically or on urodynamic investigation. Twenty years ago when the editor began attending the Repatriation General Hospital Gynaecology Clinic in Melbourne, which had a population of mainly elderly women, the overriding impression was of a group of miserable women with excoriated vulvas and urinary incontinence not amenable to surgery. Modern appliances provided in incontinence clinics and the widespread use of oestrogen has totally changed this picture but the problem of nonstress urinary incontinence remains. Many operations have been used for these patients. The present paper is written by an author with a passion for the management of women with urinary incontinence but with a frustration that this Journal has rejected his previous offerings after review by urogynaecologists with the editor's acceptance of their decisions. We have decided to publish this paper to give Dr Papa Petros a hearing. Some of the author's ideas are not easy to follow. Accordingly we asked him to encapsulate his philosophy concerning urinary incontinence in the female into about 800 words. This additional contribution is published as an epilogue to this paper; do not overlook it!

Summary: The aim was to evaluate the intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence. Fifty‐four unselected patients, aged from 26 to 79 years, mainly with mixed incontinence symptoms, underwent this procedure. It works by tightening die suburetiiral vagina (hammock), and by creating an artificial pubourethral neoligament. Where indicated, repair of uterine prolapse (24 cases), or infracoccygeal sacropexy (17 cases) was also performed. Almost all patients were discharged on the day of, or day after surgery, without requirement for postoperative catheterization, and returned to fairly normal activities, including jobs, within 7 to 14 days. At a mean follow‐up time of 15 montiis, the cure rates for preoperative symptoms were, frequency 88%, nocturia 77%, urge incontinence 89%, stress incontinence (SI) 85%, symptoms of abnormal emptying, 77%, and reduction of mean residual urine from 67.5 mLto 32 mL. The objective cure rate (exercise pad testing) for stress incontinence was 88.6%; taking the group as a whole, urine loss was reduced from a mean of 11.6 g preoperatively to a mean of 0.5 g postoperatively. Urodynamically diagnosed detrusor instability was not a predictor of surgical failure in this study. According to die concepts presented here, symptoms of urinary dysfunction are mainly symptomatic manifestations of abnormal laxity in the vagina or its supporting ligaments. The surgical methods used to correct these defects are fairly simple, safe and easily learnt by any practising gynaecologist.