Further development of the intravaginal slingplasty procedure - IVS III - (with midline 'tuck')

The intravaginal slingplasty operation (IVS III), was performed under local anaesthesia on an unselected group of 39 patients, mainly with pure stress or mixed incontinence. The artificial pubourethral ligament was created by insertion of two parallel columns of tapes. The suburethral vagina was tightened by excision of a midline segment of vagina not extending beyond bladder neck. At 12 months, the primary operation cured 70% of the stress incontinence symptoms, and 85% of the urge incontinence symptoms. A minor surgical tightening of the vaginal wall at a later date improved the total cure rate to 81% for SI. Operative failure was principally attributed to 'visco-elastic creep', a subsequent loosening of vaginal tension. Further development is required to improve the primary cure rate.