title: Vaginal wall sling: long-term outcome analysis of factors contributing to patients satisfaction and surgical success.
abstract: OBJECTIVE
  The clinical outcome of the vaginal wall sling was retrospectively evaluated to determine patient perception, satisfaction and factors contributing to postoperative success.
  
  
  METHODS
  An outcome based study was conducted of 51 patients undergoing construction of a vaginal wall sling for genuine stress incontinence or intrinsic sphincteric deficiency. Preoperative symptoms, demographic parameters and video urodynamic studies were correlated with postoperative patient perception of symptoms to determine patient satisfaction and factors contributing to overall success.
  
  
  RESULTS
  Of 42 patients (82%) available for followup 31 (74%) reported improvement in continence, 26 (62%) are currently satisfied with the urinary status, 72% in retrospect would repeat the procedure and 69% would recommended the vaginal wall sling to others. Despite long-term resolution of stress incontinence in 92% of those with genuine stress incontinence and 75% with intrinsic sphincter deficiency, postoperative urge incontinence was the single most important factor affecting patient satisfaction (p = 0.001). Patients without postoperative urge incontinence enjoyed the greatest levels of satisfaction, in excess of 90% (p = 0.001). Although preoperative leak point pressure correlated with resolution of stress incontinence, no preoperative demographic factors, symptoms or urodynamic parameters could reliably predict postoperative patients satisfaction.
  
  
  CONCLUSIONS
  The vaginal wall sling represents an excellent option for the treatment of genuine stress incontinence and an acceptable option of intrinsic sphincteric deficiency. Patient perception and satisfaction remain closely associated with presence or resolution of postoperative urge incontinence. However, prediction of postoperative urge incontinence remains a challenge and should be considered when counseling patients preoperatively.
authors.affiliation: Department of Urology, University of California Davis, Sacramento, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Litwiller
authors.forename: R S
authors.initials: RS
authors.lastname: Nelson
authors.forename: P D
authors.initials: PD
authors.lastname: Fone
authors.forename: K B
authors.initials: KB
authors.lastname: Kim
authors.forename: A R
authors.initials: AR
authors.lastname: Stone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina