Expert praises suburethral sling for stress urinary incontinence. (Downplays Osteomyelitis).

ST. LOUTS -- The trouble with most of the 170 operative procedures for stress urinary incontinence is that they don't aim to restore normal anatomy, Dr. S. Robert Kovac said at the 12th International Pelvic Reconstructive and Vaginal Surgery Conference.

Instead, these procedures seek to place the urethra in an unnaturally high retropubic position. Their goal is to obstruct urinary flow rather than to create coaptation. The operations cause a compensatory abnormality to correct the patient's original complaint, according to Dr. Kovac, the John D. Thompson Professor of Gynecologic Surgery at Emory University in Atlanta.

That's why the quoted high initial success rates-often 80%-90%--for the Burch procedure, variations on the pubovaginal sling operations, needle suspensions, and other traditional procedures often give way to a mere 50% or so long-term cure rate without subsequent problems. The patient's early satisfaction with relief of her stress urinary incontinence is eventually tempered by frustration due to detrusor instability, voiding dysfunction, urinary retention, enterocele, urethral scarring, and recurrent incontinence, he said at the conference, sponsored by the Society of Pelvic Reconstructive Surgeons.

After years of performing these operations and growing increasingly dissatisfied with the long-term results, during the early 1990s Dr. Kovac developed a procedure of his own for primary treatment of stress urinary incontinence. It is a suburethral sling attached to the posterior inferior aspect of the pubic bone, which he termed "the ideal fixation point" for restoration of the normal anatomy of continence since that is the same site where the ...