Pubovaginal sling in the treatment of stress urinary incontinence for urethral hypermobility and intrinsic sphincteric deficiency

Abstract

Purpose: This study was undertaken to evaluate the use of pubovaginal sling for the treatment of female stress urinary incontinence in patients with intrinsic sphincteric deficiency and patients with urethral hypermobility.Materials and Methods: Sixty-two patients aging 22 to 73 years-old (mean = 49.6) with a median parity of 4.1 (range 0 -14) who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence from August/1999 to August/2002 were prospectively analyzed. Objective pre and postoperative urodynamic evaluation was performed in all cases. The patients were divided into 2 groups: thirty-nine patients (62.9%) with urethral hypermobility (Valsalva leak point pressure equal or superior to 60 cm of H 2 O) and twenty-three patients (37.1%) with intrinsic sphincteric insufficiency (Valsalva leak point pressure below 60 cm of H 2 O).Results: The average follow-up period was 24.8 months, ranging from 3 to 38 months. Three patients (4.8%) had detrusor overactivity before the operation, and 36 patients (58.1%) had voiding dysfunction before surgery. The postoperative objective cure rate was 88.7% for stress urinary incontinence. The study also showed that 32.2% of the patients had voiding dysfunction and 11.3% had detrusor overactivity. The mean hospital stay was 3.1 days (range 2 -4). No difference in the above parameters was noticed between patients with intrinsic sphincteric deficiency and those with urethral hypermobility.Conclusion: Construction of a pubovaginal sling is an effective technique for the relief of severe stress urinary incontinence, for both patients with urethral hipermobility and with intrinsic sphincteric deficiency, having a cure rate of 88.7%. The high frequency of postoperative voiding urgency was not related to the detrusor overactivity as evaluated by urodynamic studies.

Comparative study of polypropylene and aponeurotic slings in the treatment of female urinary incontinence

“…Studies comparing commercially available synthetic slings with the pubovaginal fascial sling or Burch's colposuspension (13)(14)(15)(16)(17) have shown that these slings are promising, but there is still the question of cost, which is prohibitive in our situation. The option of an aponeurotic sling either from the rectus abdominis or a polypropylene mesh for the surgeon to use to construct the sling appears to be an accessible procedure, and the cost is compatible with the conditions in our clinical working environment.…”

Pubovaginal sling materials and their outcomes

“…[9] Indications Currently, PVS procedures are used primarily to treat patients with intrinsic sphincter dysfunction from a variety of difference causes. [10][11][12] However, recent studies support the notion that the PVS can be used as the primary surgical method in all of the cases of SUI. [13][14][15] PVS procedures can be successfully performed in patients with mixed urinary incontinence, neuropathic disorders that result in the loss of the closing function of the proximal urethra, acquired conditions such as a urethral diverticulum that may result in tissue loss when repaired, urethral erosions caused by a synthetic material or an artificial sphincter, and in patients who previously underwent unsuccessful incontinence surgery.…”

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

“…Some years ago, some reports showed up demonstrating good results for all types of female stress urinary incontinence as well (2)(3)(4). This major indication of the technique has been accompanied by incidences of prolonged urinary retention of 5 to 20% (4)(5)(6).…”