BERKELEY, CA (UroToday.com) - In 1996, the tension-free vaginal tape was introduced for the treatment of stress urinary incontinence in women. The ground breaking concepts included the tension-free mid-urethral placement of a monofilament Prolene mesh using a minimally invasive technique under conscious sedation. Since then, mid-urethral slings have achieved widespread use and acceptance for the treatment of stress urinary incontinence and are frequently offered as alternatives to traditional procedures such as the Burch, Marshall-Marchetti-Krantz, or fascial sling repair.

The SPARC mid-urethral sling was released by American Medical Systems in 2001 and represents an evolution of the technique in which a smaller trocar is passed from a suprapubic approach to the vagina in contrast to conventional TVT where larger trocars are passed from a vaginal approach to the suprapubic area. The potential for a lower incidence of bladder injury during placement has made this attractive to many practitioners. A recent review by M. A. Hodroff and colleagues form St. Paul, Minnesota reviews efficacy and safety data in a series of 445 patients undergoing the SPARC procedure. The manuscript is published in the October, 2005 issue of Urology.

The study group had an average age of 60 years and 348 out of the 445 patients (78%) underwent a SPARC only and 97 (22%) underwent concurrent prolapse repair or hysterectomy in addition to the SPARC. Preoperative urodynamic evaluation was performed in 297 (67%) of patients and revealed Valsalva leak point pressures ranging from 9 to 150 cm H2O. The valsalva leak point pressure (VLLP) was less than 60 cm H2O in 144 patients (48.5%). During the procedure, cystoscopy was performed after both trocars had been placed. Bladder perforations occurred 30 times (6.7%) in 26 patients. Two patients were readmitted post-operatively. One patient had a rectus hematoma that required a blood transfusion. Another presented 3 days later with abdominal pain resulting from a small bowel perforation. This patient required a laparotomy and removal of the sling. Post-operative inability to void was seen in 15 of 226 patients (6.6%) that were planned to be discharged without a catheter in place. De novo urge symptoms developed in 27 patients (6.1%) and persisted for a mean of 4.3 months. Ultimately, a sling release was performed in 19 patients (4.3%) because of obstructive symptoms or a large post-void residual. Eight small vaginal mesh extrusions (1.8%) were identified. No erosions of mesh into the urethra or bladder were observed.

Efficacy data revealed complete resolution of all stress incontinence symptoms in 83% of patients. The mean time from surgery to questionnaire completion was 15 months and 46.3% returned the questionnaire. When asked whether they would undergo the procedure again, 91% answered yes and 84% would recommend the procedure to a friend. This data, with good medium-term results, reveals the true incidence of complications and efficacy in a typical group of women undergoing the SPARC procedure for stress urinary incontinence.

Urology. 2005 Oct; 66(4):760-762