An Assessment of the Surgical Outcome and Urodynamic Effects of the Pubovaginal Sling for Stress Incontinence and the Associated Urge Syndrome

Fulford, Simon; Flynn, Richard; Barrington, J. W.; Appanna, T.; Stephenson, T. P.

doi:10.1097/00005392-199907000-00033

Cited by 96 publications

(57 citation statements)

References 13 publications

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“…This mirrors closely that reported for other surgical procedures (1). That this operation usually necessitates less vaginal dissection opposes the argument that the urge component may be lessened by incidental neural ablation occurring during the vaginal dissection (2). This high erosion rate using the OBtape® has been reported by other surgeons leading to the discontinuation of use of this material; in response, there has been a progression to new tapes such as Aris that is knitted and has a larger pore size of 550 x 170 microns.…”

Section: Editorial Commentsupporting

confidence: 82%

Neurourology & female urology

Petrou

2007

Int. braz j urol.

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Results: Pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (> or = pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p < 0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. Conclusions: Clinical to pathologic stage discrepancy is a relatively common finding after extirpative surgery for bladder cancer. Clinical outcomes after radical cystectomy are largely driven by pathologic stage. Better clinical staging is necessary to improve patient evaluation and management. Editorial CommentA large series of 778 patients with infiltrative bladder cancer undergoing radical cystectomy was retrospectively analysed and the impact of staging error calculated.Most interestingly -and not debated much in this paper -is the fact that the percentage of correct peroperative staging declined (!) over the years with correct staging around 44% until 1994 and around 35% and lower from 1995 to 2003. What happened in these periods? Was there an institutional change or did surgeons not perform TURB as thoroughly as before?Notably, downstaging moderately decreased from 26% to around 20% during these years whereas upstaging sharply increased (!) from around 28% to 43% and 49% in the later periods mentioned above.The outcomes of pathologically staged cancer finally were in the expected range with rather good results showing roughly 80% bladder cancer specific survival in organ confined disease as compared to 37% in non organ-confined disease.These data again seem to justify adjuvant chemotherapy in this high-risk group of patients. Purpose: Voiding dysfunction following genitourinary erosion of synthetic mid urethral slings is not clearly reported. We investigated the incidence of voiding dysfunction in patients following sling excision due to vaginal, urethral or intravesical mesh erosion. Dr. Andreas Bohle

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Section: Editorial Commentsupporting

confidence: 82%

Neurourology & female urology

Petrou

2007

Int. braz j urol.

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“…Previously, pubovaginal sling procedure was considered an obstructive procedure that can increase urethral resistance by placing a suburethral support against an incompetent urethra in patients with type 3 SUI [6,12,13] . In the recent decade, the indications for pubovaginal sling procedure have been extended and the treatment is now widely applied in all types of SUI [3,4,14] .…”

Section: Discussionmentioning

confidence: 99%

Long-Term Surgical Results of Pubovaginal Sling Procedure Using Polypropylene Mesh in the Treatment of Stress Urinary Incontinence

Kuo

2005

Urol Int

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Introduction: Surgery for stress urinary incontinence (SUI) in women might cure incontinence symptom butdevelop new problems. This study assessed the long-term outcome of pubovaginal sling procedure using polypropylene mesh in patients with SUI. Materials and Methods: A total of 108 patients with various types of SUI received pubovaginal sling procedure using polypropylene mesh. A surgical technique that did not create bladder outlet obstruction after operation was used in all the patients. Video urodynamic study was performed at baseline, 2 weeks and 3 months after operation. The long-term surgical results and patients’ satisfaction were assessed. Results: The age of patients ranged from 33 to 94 years (mean 62.6 ± 12.0 years). The follow-up period ranged from 24 to 72 months (median 46 months). Among the 108 patients, a successful result was noted in 92 (85.2%), including a continence rate of 65.7% and mild SUI in 19.4% of patients. Treatment failure was noted in 16 patients (14.8%), including 13 (12%) with urge incontinence and 3 (2.8%) with severe SUI that was cured by a second sling. There were 104 patients (96.3%) who could void volitionally with little residual urine, whereas 4 (3.7%) needed transvaginal urethrolysis. Urodynamic study revealed no significant changes in the mean values of parameters at 3 months after operation. However, 22 (20%) patients had an increase in voiding pressure by 50% at 3 months postoperatively. The reported satisfactory rate was 89.8%. Conclusions: Pubovaginal sling procedure using polypropylene mesh had a high success rate in all types of SUI. The continence rate was suboptimal, indicating that the absence of bladder outlet obstruction might result in inadequate urethral compression after pubovaginal sling procedure.

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“…When intra-abdominal pressure is increased, urine enters the proximal urethra, producing sensory stimulation and resulting in a reflex bladder contraction. (Fulford et al, 1999) This "urethrogenic" theory has also been supported by observations that patients with detrusor overactivity have significantly lower MUCP on urethral pressure profilometry, as well as lower angle of deflection measured by Q-tip cotton swab test. (Awad & McGinnis, 1983;Kim et al, 2010) The authors compared urodynamic characteristics, as well as physical examination findings in a retrospective study of 241 patients who were diagnosed with urinary incontinence.…”

Section: Proposed Mechanism Of Mixed Urinary Incontinencementioning

confidence: 85%