A low cost artisan tension-free tape technique cures pelvic organ prolapse and stress urinary incontinence – Proof of concept

Introduction The primary cause of pelvic organ prolapse (POP) is weak cardinal/uterosacral (CL/USL) ligaments and for stress urinary incontinence, weak pubourethral ligaments (PUL). Material and methods A 1 cm wide tape cut from a mesh sheet was applied tension-free to reinforce al-ready plicated CL/USLs for cure of prolapse and directly to PUL for cure of stress urinary incontinence (SUI). 40 tapes were inserted, 10 midurethrally for SUI and 30 for 2^nd/3^rd degree prolapse: 15 to uterosacral ligaments and 15 to cardinal ligaments. Results At 12 months there was 72% cure for POP, 70% for SUI and improvement in urge/nocturia symptoms in 82% of patients. At 36 months 8/15 patients were evaluated. Anatomic cure for POP III was 2/4, for POP I-II 6/6. Conclusions Though a ‘proof of concept’ study, our results may be sufficient to provide, in time, an alternative individual pathway for surgeons wishing to provide more certainty to a prolapse repair than ‘native tissue’ for an individual patient. The method questions whether expensive mesh kits are really necessary: our data though small, actually part of a learning curve, was within 15 percentage points of more sophisticated, more expensive tensioned slings. Intra-operative complications were low with no tape erosions seen at 12 months. Further validation with larger prospective and comparative trials is required.