The prevention of the stress urinary incontinence occurred after Laparoscopic sacrocolpopexy

Abstract

We introduced laparoscopic sacrocolpopexy (LSC) at our hospital in 2017, but we noted a high rate of de novo stress urinary incontinence (SUI) in the first 7 patients. The cause of SUI was considered to be excessive tension of the mesh. Here, we devised a method to measure the angle of the urethra using a cotton swab (modified Q tip Test; mQT), and investigated whether adjusting the tension of the mesh based on the angle measurements could prevent SUI after surgery. A cotton swab was inserted into the external urethral meatus while applying traction, and the angle of the cotton swab from the horizontal plane was measured in 6 patients. The tension of the mesh was adjusted so that the angle was between 0 to +30°and the total length of the vagina was at least 5 cm. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ SF) were administered to the patients, and the result was compared for 7 patients before mQT introduction (conventional group) and 6 patients after mQT introduction (mQT group) before and 3 months after surgery. In the conventional group, the ICIQ-SF score before and after surgery tended to worsen from 4.6 ± 5.3 (mean ± SD) to 8.0 ± 6.2, but in the mQT group, it improved from 6.3 ± 5.3 to 4.0 ± 3.7. Thus, the introduction of mQT improved the symptoms related to urinary incontinence, suggesting that adjusting the tension of the mesh using the present method may contribute to improving SUI.