Abstract
Author(s): Ahmed Alaa-el-din Wali, Rana Alaa Eldin Nasr, Munirah Mohammed Bin Mosa, Kareem Ali El-Attar, Karim El-Etriby
Background and aim: Urinary incontinence affects 27% of Egyptian women, with economic barriers limiting access to commercial slings. This study evaluated whether handmade polypropylene slings are as effective and safe as commercial systems, serving as a cost-effective alternative. Patients and methods: This retrospective study included 52 matched women (40-75 years) with primary SUI who received either a commercial or a handmade transobturator sling placed at a private tertiary care hospital in Cairo, Egypt, from July 2020 to May 2022. Outcomes included objective/subjective success, ICIQ-SF scores, complications, and pad usage, assessed over 12 months. Results: Both groups demonstrated equivalent outcomes across all measures. The handmade sling group required a longer mean operative time (39.9 vs. 34.9 minutes, p=0.032), but no other significant differences were observed in objective (84.6% vs. 80.8%, p=0.714) or subjective success rates (80.8% vs. 76.9%, p=0.735), daily pad usage (1.4 vs. 1.5 pads/day, p=0.673), catheterization time (23.2 vs. 24.8 hours, p=0.482), or complication rates (3.8% vs. 7.7%, p=0.556). Multivariate analysis confirmed sling type was not predictive of success (aOR: 1.12, p=0.564). The handmade sling was 78.6% less expensive per device ($30 vs. $140) than the commercial system. Conclusion: Handmade polypropylene slings achieve clinical outcomes equivalent to commercial systems despite a modest increase in operative time, offering a safe, effective, and cost-efficient alternative for stress urinary incontinence management.