title: Assessing outcome after a modified vaginal wall sling for stress incontinence with intrinsic sphincter deficiency.
abstract: Forty women with stress incontinence, intrinsic sphincter deficiency (ISD), associated or not with urethral hypermobility, a Valsalva leak point pressure (VLLP)<60 cmH(2)0 and a maximum urethral closure pressure<30 cmH(2)0 underwent in situ vaginal wall sling. The main modification to the technique was the use of two small Marlex meshes placed at the lateral edges of the sling. Outcome was assessed by pad use, surgical results and patients' satisfaction. Data of 39/40 patients were analyzed after a minimum follow-up of 1 year. After surgery 30/39 patients were completely dry (no pads), stress incontinence disappeared in 22/39, and 30/39 patients were satisfied with outcome. Reasons for dissatisfaction included recurrence of stress incontinence in three, infections in one and urge incontinence in five. Overall results are good given this category of patients. The vaginal wall sling can be recommended for patients with ISD because the results are promising, it corrects urethral hypermobility and, in our experience, it does not cause obstruction if correctly performed.
authors.affiliation: Department of Urology, University of Perugia, Via Brunamonti 51, 06100 , Perugia, Italy. uropg@rdn.it
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Costantini
authors.forename: Luigi
authors.initials: L
authors.lastname: Mearini
authors.forename: Ettore
authors.initials: E
authors.lastname: Mearini
authors.forename: Cinzia
authors.initials: C
authors.lastname: Pajoncini
authors.forename: Federico
authors.initials: F
authors.lastname: Guercini
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bini
authors.forename: Massimo
authors.initials: M
authors.lastname: Porena
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016496:Incontinence Pads / Q000706:statistics & numerical data; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000150:complications*; D014550:Urinary Incontinence, Stress / Q000209:etiology* / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D014621:Vagina / Q000601:surgery*