Effects of pubovaginal sling procedure on patients with urethral hypermobility and intrinsic sphincteric deficiency: would they do it again?
OBJECTIVE
This study was undertaken to assess the cure rate of stress urinary incontinence, long-term effects on other lower urinary tract symptoms, and quality of life in a cohort of patients who underwent pubovaginal sling procedures for treatment of incontinence related to intrinsic sphincteric deficiency and urethral hypermobility.


METHODS
This was a retrospective analysis of 57 patients with 90% follow-up who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence related to urethral hypermobility and intrinsic sphincteric deficiency. Objective postoperative urodynamic evaluation was performed in 34 (60%) of the cases. Telephone interviews to assess quality-of-life parameters were performed in all cases.


RESULTS
The mean follow-up period was 42 months and the median follow-up period was 34 months, with a range of 0.5 to 134 months. The age at the time of the sling procedure ranged from 18 to 84 years, with a median parity of 3.0 (range, 0-6). Preoperative body mass index ranged from 19.5 to 39.1 kg/m(2). Five percent of patients had detrusor instability before the operation. Forty-one percent (41%) of the patients who underwent postoperative urodynamic evaluation had voiding dysfunction. The postoperative objective cure rate for stress urinary incontinence was 97%. Of all patients 88% indicated that the sling had improved the quality of life, 84% indicated that the sling relieved the incontinence in the long-term, and 82% would choose to undergo the procedure again.


CONCLUSIONS
Construction of a pubovaginal sling is an effective technique for relief of severe stress urinary incontinence. Voiding dysfunction is a common side effect. Despite this problem, a significant number of patients would elect to undergo the procedure again.
Richter
H E
HE
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Varner
R E
RE
Sanders
E
E
Holley
R L
RL
Northen
A
A
Cliver
S P
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005206:Fascia Lata / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011630:Pubic Bone; D011788:Quality of Life; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology*; D001743:Urinary Bladder; D014550:Urinary Incontinence, Stress / Q000503:physiopathology* / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology; D014563:Urodynamics; D013520:Urologic Surgical Procedures; D014621:Vagina / Q000601:surgery