Expert: Synthetic materials are preferred for stress incontinence surgery

Synthetic materials work much better than biological ones for surgical treatment of stress urinary incontinence, in the experience of Shlomo Raz, MD, of UCLA.

"The best operation is the one that works best in your hands," Dr. Raz said Saturday at the Urology Congress here. "In my practice, I have abandoned almost completely the use of biomaterials."

Dr. Raz said a wide variety of biological materials have been tried for this type of surgery: porcine, autologous, and cadaveric. He grouped them together in the category of biomaterials, and said they shared the same basic advantages: less vaginal extrusion and less infection.

But the biomaterials also have disadvantages, which, in his experience, outweigh the advantages: they are more expensive, they contain DNA fragments (the implications of which are unclear), they are prone to rejection and absorption, and results are inconsistent in the long term.

"We used cadaveric fascia," he said. "It was the worst surgery I have ever done for stress urinary incontinence-the material disappeared."

As an example of the cost difference, he pointed out that fascia can cost up to $700. By contrast, Dr. Raz cuts his own soft prolene mesh at a cost of only $15.

"It's very thin and very pliable," he said.

He warned against choosing a multifilament material, which is less porous than the prolene mesh. The problem, he said, is that bacteria can enter between the multifilaments while macrophages and polymorphonuclear leukocytes cannot.

Dr. Raz cited a prospective, randomized study on operations using tension-free vaginal tape. It found that 59% of patients reported themselves to be cured of stress incontinence, and 36% had no leakage whatsoever.

Such results are more meaningful than reports that show success as measured by the physicians rather than the patients, he said.

"When you read a paper and you see 95% success rate, read the fine print," he advised.