title: Is the anterior vaginal wall sling a good alternative for intrinsic sphincteric insufficiency?
abstract: OBJECTIVE
  We present our experience with the anterior vaginal wall sling, in the treatment of patients with stress urinary incontinence (SUI) due to urethral intrinsic sphincteric deficiency.
  
  
  METHODS
  Forty-five women (mean age 53.4 years) with urodynamically proven intrinsic sphincteric deficiency (Valsalva Leak Point Pressure below 60cm H(2)O) were studied, prospectively. Coexisting bladder neck hypermobility was assessed using transperineal ultrasound. Patients with severe pelvic prolapse (grade 3 or 4) were excluded. Multivariable logistic regression was used to identify the variables that influenced the outcome (statistical significance was established for p<0.05). Follow-up ranged from 26 to 61 months (mean 40 months).
  
  
  RESULTS
  Complete SUI cure was achieved in 14 women (31.1%) and 17 other women (37.8%) described SUI improvement and were satisfied with the outcome. Statistical analysis showed that factors such as age below 35 years (p=0.0251), and preoperative bladder neck hypermobility (p=0.0176), were strongly related to postoperative continence.
  
  
  CONCLUSIONS
  We concluded that the vaginal wall sling has a high rate of failure in the treatment of patients with intrinsic sphincteric deficiency. This technique should not be proposed if hypermobility is not associated, especially in the case of elderly patients.
authors.affiliation: Division of Urology, School of Medicine, State University of Campinas, SP, Brazil.
authors.forename: Paulo C R
authors.initials: PC
authors.lastname: Palma
authors.forename: Cassio L Z
authors.initials: CL
authors.lastname: Riccetto
authors.forename: Aderivaldo C
authors.initials: AC
authors.lastname: Dias Filho
authors.forename: Míriam
authors.initials: M
authors.lastname: Dambros
authors.forename: Marcelo
authors.initials: M
authors.lastname: Thiel
authors.forename: Nelson R
authors.initials: NR
authors.lastname: Netto