A further assessment of the gauze hammock sling operation in the treatment of stress incontinence.

A further series of 100 consecutive gauze hammock sling operations for urinary stress incontinence is presented with preliminary urodynamic assessment in all cases and follow-up from 6 months to 5 years. In 63 women the operation was a primary procedure. Modification to the operation included redesign of the shape of the sling, use of increased tension where minor degrees of bladder detrusor instability exist, and use of a suprapubic catheter postoperatively. Of the 100 women 87 were reviewed directly and 12 indirectly; only one was lost to follow-up. After operation, 78% were continent, 17% showed improvement and there were 4% failures. The only serious complication was a pulmonary embolus in one woman but 15 had some voiding difficulty during the follow-up period which responded to urethral dilatation in all but three. There were no fistulas. This improved technique should overcome many of the objections to the sling procedure and is a suitable primary procedure for stress incontinence or for treatment of recurrence after previous alternative procedures.