Experience with Silastic Slings for Female Urinary Incontinence
Authors: Korda Andrew , Peat Brian , Hunter Peter 
Published: February 2008

EDITORIAL COMMENT: Peter Dwyer, Melbourne. Traditionally gynaecologists have used the anterior vaginal repair to treat stress incontinence in the female but over recent years there has been a trend to perform retropubic urethral suspension operations or slings in all patients with stress incontinence to improve the long‐term effectiveness of surgery. In this paper, a silastic sling was used mainly to treat primary stress incontinence in women with a high risk of failure from chronic lung disease or who had restricted vaginal mobility and were considered unsuitable for Burch colposuspension. Nine of the 54 women had recurrent stress incontinence with failed previous suprapubic surgery.The success of a surgical procedure can be judged by its effectiveness in relieving symptoms, its simplicity, the incidence of postoperative complications and finally by its general acceptance by practising gynaecologists. The early symptomatic cure rate using a silastic sling in women with no previous suprapubic surgery was good although the high incidence of voiding problems and detrusor instability postoperatively would be unacceptable to many gynaecologists and their patients. The purpose of inserting synthetic slings or artificial urethral sphincters through an abdominal incision is to avoid vaginal contamination so it was interesting that the incidence of infection was low where an abdominovaginal approach was used.Finally treatment of predisposing factors such as a weak pelvic floor, obesity, chronic lung disease, menopausal atrophy and coexisting detrusor instability will frequently improve stress incontinence and should always be considered prior to surgical intervention.ADDITIONAL EDITORIAL COMMENT: Robert Zaeharin, Melbourne. This paper, like all its predecessors describing and advocating suburethral sling procedures to correct stress incontinence of urine, suffers the same and obviously continuing problems — the usual vague anatomical details with regard to siting of the sling and the well known difficulties in assessing tension.Clearly inaccurate sling placement or incorrect tension leads to failure or voiding difficulties.Finally, foreign material, however apparently inert, in close relation to bladder and urethra is best avoided.Such built‐in problems with the sling procedures are reflected in the figures — of 54 patients, 11 were not cured of their stress incontinence and 20 suffered voiding difficulty — relieved in 15 by subsequent sling readjustment, but how this was gauged is unstated. Eight patients exchanged stress incontinence for urge incontinence and it is likely some slings will need eventual removal to correct this.Advocacy of such techniques to correct recurrent stress incontinence needs careful consideration of these real problems and full discussion with explanation to prospective patients is most important.Summary: Between September 1, 1985 and December 31, 1987, 54 patients with stress urinary incontinence were treated with a reinforced silastic sling using an abdominovaginal approach; 42 patients were cured, two improved and nine were the same or worse. Five patients who are continent required periodic intermittent self‐catheterization. Eight patients developed detrusor instability postop‐eratively. One patient had to have the sling removed due to a persistent sinus. Fifteen patients had to have the sling adjusted.