The modified rectus fascial sling for the treatment of genuine stress incontinence.

We aimed to assess the results of the modified rectus fascial sling for the treatment of genuine stress incontinence (GSI), using an observational study of patients at a South Wales Teaching Hospital. Seventy-three patients with proven GSI underwent a modified rectus fascial sling. Thirty-seven also had a significant urge component to their symptoms though only two had demonstrable detrusor instability. Fifty-one had undergone previous incontinence surgery. All had pre-operative videourodynamics and 50 agreed to follow up urodynamics. Of these who had undergone previous surgery 48 (94%) were subjectively dry, though four (8%) still demonstrated GSI on videourodynamics. There were no failures in the previously unoperated group. Three require long-term intermittent self-catheterisation and three others catheterise occasionally. Overall, 29 patients (78%) were improved or cured of their urge component but three were worse, with urge incontinence. From our data, it seems that the modified rectus fascial sling is superior to standard techniques for GSI especially in patients who have undergone previous surgery. However loosely the sling is placed, a small but significant group are obstructed by the procedure, and may require self-catheterisation.