Modified Pubovaginal Sling for Treatment of Intrinsic Sphincteric Deficiency

Abstract

Our study confirmed the success of the modified pubovaginal fascial sling for treatment of intrinsic sphincteric deficiency. We were unable to obtain useful preoperative information from fluoro-urodynamic studies to predict which patients would experience failure to return to normal voiding.

Long term follow up of the cruciate fascial sling for women with genuine stress incontinence

“…Our results are disappointing compared with other studies that have reported ‘cure’ of stress incontinence in over 90% of women using sling procedures 6,9,31,33–45 . However, all these studies report on both shorter follow up and use non‐validated methods of assessing subjective improvement.…”

“…However, all these studies report on both shorter follow up and use non‐validated methods of assessing subjective improvement. For a number of these authors women are considered cured even if they suffer continuing incontinence, as long as that incontinence is due to detrusor instability 6,36–39 . In our study urgency was strongly associated with failure of the operation.…”

“…Most authors consider the woman's opinion of the surgery and quote a subjective cure rate. However, the methods used to assess this are variable, with some reports giving no information 4,8,14,23,34,48–52 , while others use chart review 43,53 , patient interviews or questionnaires that have not been validated 7,10,15,16,18,19,21,25–27,29,33,37–39,54,55 . Some authors feel that subjective cure is unimportant and report only objective cure as assessed by one‐hour pad test 56 , urodynamics 6,20,35,41,57–59 , or provocative testing with varying amounts in the bladder 5,9,17,40 .…”

Sling techniques in the treatment of genuine stress incontinence

“…Sling insertion utilising a combined vaginal and abdominal approach, a vaginal approach alone or a suprapubic technique alone, with blind dissection beneath the urethra and bladder base, have all been described. The use of an abdominal approach alone is claimed to reduce bacterial contamination of the sling although the incidence of bladder and urethral injury may be slightly higher 12 . However, there is no definitive evidence to indicate which surgical approach is superior and this appears to be related to the preference and experience of the surgeon; it is the choice of material and tension which appear to most influence the outcome of sling surgery.…”

Mixed symptomatology

“…However, successful surgery for stress incontinence has an effect on urge incontinence symptoms and on detrusor instability identified with CMG. Most reports show a 50-75% resolution rate of detrusor instability and urinary incontinence symptoms after successful surgery for stress incontinence [40][41][42][43][44][45]. Cucchi [33] found a relationship between stress incontinence and detrusor instability in some patients, which he suggested was causal.…”