Trocar-assisted sling suspension for stress urinary incontinence

Study Objective. To introduce a new approach in trocar-assisted sling suspension (TASS) for genuine stress incontinence. Design. Prospective, observational study (Canadian Task Force classification II-2). Setting. University-affiliated hospital. Patients. Twenty-four women with genuine stress incontinence. Intervention. TASS. Measurements and Main Results. After standard preparation and under general endotracheal anesthesia, the periurethral space and thicker part of pubocervical fascia was opened from the vagina. An 0.5-cm incision was made on both sides of the lower abdomen 4 cm lateral to the linea alba and 2 to 3 cm above the pubic bone. A trocar was used to penetrate the incision site to the space of Retzius. A folded polypropylene mesh, 2 cm wide and 30 cm long, inside the vagina was pulled outside the trocar with laparoscopic forceps. All procedures were completed as planned. Average blood loss was less than 50 ml and operating time was 20 to 90 minutes. One woman had voiding difficulty and two had detrussor instability, but no bladder injury occurred (overall complication rate 12.5%). At 2-year follow-up, 23 of 24 women were satisfied with the results. Conclusion. TASS is a feasible surgical procedure for managing stress incontinence. Since urinary incontinence surgery is usually combined with other gynecologic procedures, the laparoscopic trocar that is used during TASS can be used for concurrent surgery.