Role Of Sling Integrity In The Restoration Of Leak Point Pressure In The Rat Stress Urinary Incontinence Model

Purpose We tested the hypothesis that cutting the sling at its suburethral section does not cancel its anti-incontinence effect, i.e.(id est) tested the principle of tension-free in vaginal sling.Material and Methods Stress urinary incontinence was created in 40 female Wistar rats by the previously established method of continuous vaginal distension (VD). Under 10% urethane anesthesia ,10 animals received a vaginal sling; 10 received a vaginal sling in which the suburethral portion of the sling was cut immediately after placement ; 10 received a vaginal sling in which the suburethral portion of the sling was cut half immediately after placement ,and 10 received a sham vaginal sling. Six weeks after the procedures crede maneuver induced abdominal leak point pressure (ALPP) was determined and a cystometrogram (CMG) was done using anesthesia in each animal via a previously implanted suprapubic catheter. Kruskal-Wallis and pairwise separate rank multiple comparison tests were performed with a significance level of 0.05.Results The cut,cut half and intact slings increased abdominal leak point pressure (ALPP) similarly and these values were significantly higher than that of the sham sling (24.9, 26.7 and 27.9 cm H2O, respectively, vs 20.7, p <0.0001). Peak micturition pressure was not significantly different among the 4 groups, indicating absent bladder outlet obstruction in the sling groups. Bladder compliance was significantly decreased 6 weeks after placement of a cut or cut half or intact sling compared with the sham sling (p = 0.007,0.05 and 0.05, respectively).Conclusions An intact suburethral portion is not a requirement for sling effectiveness in the rat model of stress urinary incontinence. However, the sling procedure decreases bladder compliance. This may explain the observed voiding dysfunction associated with sling procedures.