Midurethral tissue fixation system sling - A 'micromethod' for cure of stress incontinence - Preliminary report

Aims: To assess the effectiveness of the Tissue Fixation System (TFS) in patients with stress incontinence. The TFS uses two small plastic anchors to fix an (adjustable) midurethral polypropylene mesh sling into the soft tissues below the pubic bone. Patients and methods: Thirty-six patients with stress incontinence, mean age 55 (35-87), mean weight 76 kg (33-117 kg), mean 0.8 previous operations for stress incontinence, underwent a TFS midurethral sling operation. The patients were preoperatively assessed with a structured questionnaire, 24-h urinary diary, cough stress test, transperineal ultrasound, and urodynamics. Using the TFS delivery system, a midurethral mesh tape was attached to the fibromuscular tissues behind the perineal membrane. The suburethral vaginal fascia was also tightened. Post-operatively. the patients were reviewed at 6 weeks, and at 3-monthly intervals with ultrasound, and cough stress tests. Results: Primary symptomatic cure rate at mean 9 months (3-15 months) was 83.4% (n = 36). Pad test loss decreased from a mean 12.7 g to a mean of 0.2 g; mean operating time was 5 min, and mean hospital stay was 24 h (12-48 h). There were no cases of obstructed micturition, and minimal analgesia only was required postoperatively. Conclusion: The TFS is a promising new method. The results at this stage are similar to those achieved previously with the 'tension-free' tape operations, but with greater safety and shorter operating time. Testing by other surgeons will be required to evaluate this method further.