Stress urinary incontinence is a condition in which involuntary loss of urine during an increase in intrabdominal pressure(laughing, coughing, sneezing, exercising, lifting etc). The main cause is due to lack of urethral support from the pelvic floor muscle weakness. The other cause may be due to intrinsic sphincter deficiency(ISD) which is can be due to pelvic surgeries. ISD results in urine loss usually at a lower abdominal pressure.
Treatment includes pelvic muscle rehabilitation which includes Kegel Exercises, biofeedback, vaginal weight training, and pelvic floor electrical stimulation. Behavioral therapies include bladder retraining, timed voiding, prompted voiding, decreasing fluid intake, and eliminating caffeine from their diet. Other conservative treatment options include alpha-agonists such as pseudoephedrine and phenylpropanolamine. Anti incontinent devices include pessaries, urethral occlusion devices and absorbent pads. However, definitive cure usually requires surgery. Currently, I am using the Transobturator Vaginal Sling. This requires three small incisions. One vaginal incision and one incision in each groin.
One of the latest surgical treatments is the Solyx which is a single incision sling made by Boston Scientific.   This is a midurethral sling just as the transobturator sling. The mesh is made of polyprophylene material. The mesh is inserted through the vaginal incision. In theory, the placement of this mesh avoids injury critical structures such as the obturator artery or obturator bundle.Â
There is an article "Preliminary findings with the Solyx single incision sling system in female urinary incontinence" which was published in the International Urogynecology Journal. This was a retrospective study of 63 women who had undergone implantation at three medical centers during December through March of 2009. Mean followup was 6.5 months. 95% were dry on the basis of subjective and objective assessment. Two patients experienced transient urinary retention which resolved spontaneously. No complication such as bladder injury, bowel injury, vascular injury, nerve injury, or erosions of mesh. No pain was reported that was attributed to the implant.Â
In summary, for those who are interested in a surgical procedure for stress urinary incontinence, the Solyx single incision sling appears to offer a minimal invasive option. The risk of this procedure appears less but the long term efficacy remains to be seen.
Jeffrey Wong, MD, FACS
Treatment includes pelvic muscle rehabilitation which includes Kegel Exercises, biofeedback, vaginal weight training, and pelvic floor electrical stimulation. Behavioral therapies include bladder retraining, timed voiding, prompted voiding, decreasing fluid intake, and eliminating caffeine from their diet. Other conservative treatment options include alpha-agonists such as pseudoephedrine and phenylpropanolamine. Anti incontinent devices include pessaries, urethral occlusion devices and absorbent pads. However, definitive cure usually requires surgery. Currently, I am using the Transobturator Vaginal Sling. This requires three small incisions. One vaginal incision and one incision in each groin.
One of the latest surgical treatments is the Solyx which is a single incision sling made by Boston Scientific.   This is a midurethral sling just as the transobturator sling. The mesh is made of polyprophylene material. The mesh is inserted through the vaginal incision. In theory, the placement of this mesh avoids injury critical structures such as the obturator artery or obturator bundle.Â
There is an article "Preliminary findings with the Solyx single incision sling system in female urinary incontinence" which was published in the International Urogynecology Journal. This was a retrospective study of 63 women who had undergone implantation at three medical centers during December through March of 2009. Mean followup was 6.5 months. 95% were dry on the basis of subjective and objective assessment. Two patients experienced transient urinary retention which resolved spontaneously. No complication such as bladder injury, bowel injury, vascular injury, nerve injury, or erosions of mesh. No pain was reported that was attributed to the implant.Â
In summary, for those who are interested in a surgical procedure for stress urinary incontinence, the Solyx single incision sling appears to offer a minimal invasive option. The risk of this procedure appears less but the long term efficacy remains to be seen.
Jeffrey Wong, MD, FACS
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