Open Access

RESIDENT’S CORNER

Comparison of recovery from postoperative pain utilizing two sling techniques

Victor H. Hartanto, David DiPiazza, Murali K. Ankem, Carmen Baccarini, Nancy J. Lobby

Department of Surgery, Division of Urology, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA
Address correspondence to Victor Hartanto, MD, UMDNJ-RWJ Medical School, Division of Urology, 1 Robert Wood Johnson Place MEB 588, New Brunswick, New Jersey 08903 USA

Canadian Journal of Urology 2003, 10(1), 1759-1763.

Abstract

Materials and methods: A total of 64 women (mean age = 57) were treated for stress urinary incontinence secondary to intrinsic sphincter deficiency or hypermobility between March 1998 to August 2000. Group I (SPWS) consisted of 30 patients who underwent in situ vaginal wall sling with suprapubic placement of bone anchors in the pubic tubercle utilizing the Vesica system. Group II (TVCS) consisted of 34 patients who underwent cadaveric fascia sling with transvaginal placement of bone anchors behind the symphysis pubis utilizing the Precision-TAC system. Phone interviews were conducted by a third party who was blinded to the details of the surgical technique, to assess pain at various postoperative times as well as current level of continence. The pain assessment was done using the Verbal Pain Assessment Scale (VAS). Complete continence was defined as dryness with no pad use.
Results: Significant differences were discovered in both days to pain free state and operative time. No other differences were detected in continence or length of hospital stay. Based on the VAS, a pain free state was achieved for the TVCS group in 1.33 days and for the SPWS group in 9.7 days with p=0.00043. Mean operative time for the SPWS group was 96.9 minutes for the sling alone and 106.7 minutes when combined with cystocele repair. Mean operative time for the TVCS group was 75.36 minutes for the sling alone and 98.11 minutes when combined with cystocele repair. No patient in either group developed osteomyelitis, osteitis pubis, removal of the bone anchors for any reason, nor sling erosion. Seventy percent and 83.3% patients were completely dry (mean follow-up 12.5 months, range 3-30 months) in the SPWS and TVCS group, respectively.
Conclusion: A pain free state is achieved faster in patients undergoing transvaginal placement of bone anchors compared to bone anchors placed suprapubically. Bone anchors used in sling procedures are safe and achieve acceptable short term continence rates.

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