title: Expanded indications for the pubovaginal sling: treatment of type 2 or 3 stress incontinence.
abstract: OBJECTIVE
  The usefulness of the pubovaginal sling procedure as primary treatment of stress incontinence associated with urethral hypermobility (type 2) or intrinsic sphincter deficiency (type 3) was determined.
  
  
  METHODS
  A total of 60 consecutive cases of type 2 or 3 stress urinary incontinence was treated with a pubovaginal sling by 1 surgeon using a previously reported technique. Fluoroscopic urodynamic studies with leak point pressures were used to classify the type of incontinence. Of the 60 women 38 (63%) were diagnosed with type 2 and 22 (37%) with type 3 stress urinary incontience. Of these patients 24 had previously undergone 1 or more anti-incontinence procedures.
  
  
  RESULTS
  At a mean followup of 25 months 57 of the 60 patients (95%) were completely continent. In addition, 69% of patients with urgency had resolution of the urgency symptoms following the sling procedure. Transient postoperative urinary retention (median duration 6.5 days) was present in 60% of the patients. However, all women subsequently voided spontaneously without requiring further intermittent or Foley catheterization. Other complications occurred infrequently, and included urinary tract infection (13% of cases), de novo urgency (12%) and persistent incisional pain (5%).
  
  
  CONCLUSIONS
  These early results suggest that the pubovaginal sling is a safe and effective treatment for primary or recurrent type 2 or 3 stress incontinence. The most worrisome complication, urinary retention, occurred temporarily in more than half of the patients but eventually resolved in all cases, usually within 10 days.
authors.affiliation: Department of Surgery (Urology), Kent General Hospital, Dover, Delaware, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Zaragoza
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011630:Pubic Bone; D013514:Surgical Procedures, Operative / Q000379:methods; D014550:Urinary Incontinence, Stress / Q000145:classification / Q000601:surgery*; D014621:Vagina