Vaginal Wall Sling for Female Stress Urinary Incontinence: Efficacy and Outcome Analysis

PURPOSE: The objective of this study was to assess the efficacy and clinical outcome of vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: A total of 37 patients with stress urinary incontinence underwent vaginal wall sling procedure by a single surgeon from January 1998 to December 2001. All patients were evaluated preoperatively with detailed history, physical examination, urinalysis, abdominal ultrasonography, Q-tip test and stress provocation test. The 4 sutures comprising vaginal wall sling (two at the level of mid-urethral complex and two at the level of bladder neck) provide a rectangle of support and compression from the bladder neck to the mid-urethra. The efficacy and clinical outcomes of this procedure were evaluated. RESULTS: With a mean follow-up of 19.2 months(5 to 46 months), 30 patients(81%) failed. Mean operation time was 63.3 minutes. Mean duration of indwelling catheter was 5.2 days and mean duration of hospitalization was 7.2 days. One patient(2.7%) suffered from prolonged voiding difficulty for 30 days. One patient(2.7%) had postoperative bleeding necessitating blood transfusion. De novo urge incontinence developed in 3 patients(8.1%). Other transient minor complications were urinary tract infection(13 cases), suprapubic discomfort(5 cases), and urgency(4 cases). CONCLUSIONS: We consider that vaginal wall sling is a simple and effective procedure for the treatment of stress urinary incontinence, though longer follow-up is necessary to assess the long term effect.

Comparison of Using Anterior Vaginal Wall and Cadaveric Fascia Lata in Sling Operation for the Management of Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Sling procedures have become the gold standard for treating all types of stress urinary incontinence (SUI) in women because of their simplicity of procedure and good outcomes. We compared the outcomes of anterior vaginal wall sling with cadaveric fascia lata sling. MATERIALS AND METHODS: Between October 1996 and April 2000, 43 women with SUI who were treated with anterior vaginal wall sling and 23 women with SUI who were treated with cadaveric fascia lata sling were analyzed. Mean follow-ups were 43.0 months (29-56) for anterior vaginal wall sling and 21.5 months (16-30) for cadaveric fascia lata sling. All patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary, and urodynamic study including Valsalva leak point pressure. Parameters of comparison included presence of stress incontinence, length of hospital stay, duration of catheterization, operation time, and complication and success rates. RESULTS: The success rates, including satisfaction rates, were 83.7% in the anterior vaginal wall sling group and 82.6% in the cadaveric fascia lata sling group. The complication rates were 23.3% in the anterior vaginal wall sling group and 26.1% in the cadaveric fascia lata sling group. CONCLUSIONS: Both procedures were equally effective in the management of female SUI with high cure rates and acceptably low complication rates. However, further long-term follow-up study of these procedures is required to determine the persistence of the good results in women with SUI.

Comparison between Anterior Vaginal Wall Sling and Pubovaginal Sling Using Cadaveric Fascia Lata for the Treatment of Female Sphincteric Incontinence / 대한비뇨기과학회지

PURPOSE: Sling procedure has been performed mainly in stress urinary incontinence (SUI) patients with intrinsic sphincteric deficiency (ISD). The purpose of this study was to compare the safety and efficacy of anterior vaginal wall sling with pubovaginal sling using cadaveric fascia lata in the treatment of women with ISD. MATERIALS AND METHODS: Among 43 patients with ISD who had received sling procedure, we retrospectively compared 21 women treated with anterior vaginal wall sling (Group A) to 22 women treated with pubovaginal sling using cadaveric fascia lata (Group B). Preoperative evaluations included cystourethrography, urodynamic study and incontinence staging with SEAPI (stress-related leakage, emptying ability, anatomy, protection and inhibition) classification. The operation time, rate of complication, duration of suprapubic catheterization, length of hospital stay, postoperative presence of stress or urge incontinence, and satisfaction scores were checked. RESULTS: In group A, 17 patients (81.0%) were cured and 3 (14.3%) showed improvement within 14.2 months of mean follow-up, whereas in group B, 18 patients (81.8%) were cured and 3 (13.6%) showed improvement within 13.5 months. De novo urgency was presented in 2 patients (9.5%) from group A and 1 (4.5%) from group B. There was no statistically significant difference between the 2 groups in terms of complication rates and postoperative subjective SEAPI scores. CONCLUSIONS: We concluded that anterior vaginal wall sling and pubovaginal sling using cadaveric fascia lata are both effective surgical treatments for SUI with ISD.

Result and Factors Contributing to Patients' Satisfaction of Anterior Vaginal Wall Sling Operation / 대한비뇨기과학회지

PURPOSE: Due to their high success rate, sling operations have recently been widely performed for stress urinary incontinence (SUI) associated with intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite the encouraging short-term results of the sling surgery using anterior vaginal wall, the long-term results have been shown not to be as good as those in short-term studies. This study was designed to investigate the long term results of a Raz's anterior vaginal wall sling (AVWS), and to determine factors contributing to patients' satisfaction. MATERIALS AND METHODS: An outcome-based study was conducted on 77 patients who had undergone an AVWS performed by the same surgeon. Patients were preoperatively evaluated for their history, by physical examination, standardized symptom questionnaires and urodynamic studies. Patients with a follow-up of at least 1-year were assessed by the parameters of voiding symptoms and subjective satisfaction from the postoperative questionnaires. RESULTS: Of the 62 patients (81%) available for long term follow-up, 43 (69.4%) were currently satisfied with the urinary status, 35 (56.5%) were dry all the time, 12 (19.4%) were occasionally wet, but the severity had improved, 15 (24.1%) had not improved or had worsened. A review of the charts of the 15 failures revealed all of them were postoperatively urgent. Late complications occurred in 4 patients; 1 had recurrent cystocele and 3 had dyspareunia. De novo urge incontinence occurred in 5 patients. CONCLUSIONS: The stress incontinence was cured, or improved, in 75.8% of the patients after a follow-up of at least 1-year. The satisfaction of patients was closely associated with the presence, or resolution, of postoperative urgency or urge incontinence.

Anterior Vaginal Wall Sling for Female Stress Urinary Incontinence / 영남의대학술지

BACKGROUND: The purpose of this study was to determine the efficacy and safety of the anterior vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: From January 1998 to December1999, 42 patients(31 with genuine stress urinary incontinence and 11 with mixed urinary incontinence, 38 with anatomical incontinence and 4 with intrinsic sphincteric deficiency) underwent anterior vaginal wall sling at Yeungnam University Hospital were studied retrospectively. The mean age was 49.3 years(ranging from 34 to 66 years of age) and the mean follow-up period was 29.4 months(ranging from 16 to 40 months). Intra- and postoperative complication, success rate and patient's satisfaction were evaluated. RESULTS: The mean operation time was 79 minutes(ranging from 65 to 124 minutes) and the mean hospital stay was 5.1 days(ranging from 4 to 10 days). Mean postoperative Foley catheter drainage was 2.1 days(ranging from 1 to 5 days). As a complication, bladder perforation occurred in one patient(2.4%), residual urine sensation developed in seven patients(16.7%). and suprapubic pain was complained in five patients(11.9%). which improved gradually. Vaginal epithelial inclusion cyst occurred in one patient(2.4%) at postoperative 31 months. Four(9.4%) patients with de novo instablility were improved by anticholinergics medication. The success rate was 92.9% and 38 patients(90.5%) were satisfied with this procedure. CONCLUSION: We consider that the anterior vaginal wall sling to be a safe and effective surgical procedure for the treatment of female stress urinary incontinence. but a longer follow-up is necessary to determine long term effect.

The Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence: long-term follow-up results

PURPOSE: Sling operation has been known the best treatment of woman with anatomical urinary incontinence(AI) and intrinsic sphincteric deficiency(ISD). We evaluated the clinical outcome of anterior vaginal wall sling as a treatment for stress urinary incontinence. MATERIALS AND METHODS: Thirty three patients with stress urinary incontinence who treated with anterior vaginal wall sling from October 1995 to March 2000 were analyzed. Patients were evaluated preoperatively with history, physical examination, voiding cystourethrography, evaluation with SEAPI classification and urodynamic study including of Valsalva leak point pressure(VLPP) and maximal urethral closing pressure(MUCP). All patients were assessed for the outcome of the procedure and subjective satisfaction by questionnaires. Surgical outcomes were then analyzed in relation to VLPP , MUCP and subjective SEAPI score. Of the total 33 patients, 26(78.8%) had AI and 7(21.2%) had ISD. According to the Stamey grades, 6(18.2%) were grade I, 23(69.7%) were grade II and 4(12.1%) were grade III. RESULTS: With a mean follow-up of 42.4 months (range 14 to 66). Urinary incontinence completely disappeared in 20 patients(60.6%), significantly improved in 8 patients(24.2%), failed in 5 patients(15.2%). Complication included urinary retention in two patients, suprapubic pain in two patients, and urge incontinence in two patients. Pre- and postoperative urge incontinence was major factor for failure rate. CONCLUSIONS: Anterior vaginal sling operation is a simple, safe and effective procedure for treatment of both AI and ISD. The urge incontinence is closely related to success rate.

Comparison of Anterior Vaginal Wall Sling and Pubovaginal Fascial Sling in the Management of Intrinsic Sphincteric Deficiency / 대한비뇨기과학회지

PURPOSE: Pubovaginal sling using a strip of rectus fascia to compress the urethra has been the best known treatment for the stress urinary incontinence caused by intrinsic sphincteric deficiency. Recently, sling procedure utilizing the anterior vaginal wall have come forth and the procedure appeared to be performed easily more than the pubovaginal sling. The aim of this study was to compare the safety and efficacy of the pubovaginal versus the anterior vaginal wall slings in treating women with intrinsic sphincteric deficiency. MATERIALS AND METHODS: We retrospectively compared 12 women treated with pubovaginal slings(Group I) for intrinsic sphincteric deficiency to 15 women treated with anterior vaginal wall slings(Group II). Parameters of evaluation included the postoperative presence of stress or urge incontinence, operation time, complications, duration of suprapubic catheterization, hospital stay, days lost from work, and satisfaction score. RESULTS: Baseline clinical and urodynamic data were comparable for both groups. With a mean follow-up of 22 months(range 9-30) for group I, 12(100%) were cured. In group II, with a mean follow-up of 18 months(range 15-20), 14(93%) were cured and 1(6.7%) improved. Postoperative de novo urge incontinence was present in 1(6.7%) patient in group II. Group I(100%) and group II(93%) were either very satisfied or somewhat satisfied with their surgical outcome. The operative time and hospital stays of group II were significantly lower than those of group I. There were no statistically significant differences between the 2 groups in catheterization duration and days lost from work. CONCLUSIONS: We concluded that both techniques are equally effective in treating women with stress incontinence caused by intrinsic sphincteric deficiency. However, the use of anterior vaginal wall slings resulted in significantly shorter operative time and hospital stay compared with pubovaginal slings. Therefore, the anterior vaginal wall slings may be the preferable surgical method in treating intrinsic sphincteric deficiency.

In Situ Anterior Vaginal Wall Sling in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The clinical outcome of the in situ anterior vaginal wall sling with bone anchor suture fixation was evaluated to determine the efficacy and safety in the treatment of women with anatomical incontinence(AI) and intrinsic sphincteric deficiency(ISD). MATERIALS AND METHODS: 62 women(45 with AI and 17 with ISD) underwent this modified sling procedure with the sling anchored to the pubic bone. Preoperative evaluation included detailed history, physical examination, urinalysis, urodynamic test, Q-tip test and incontinence staging with Stamey grade. All patients were followed up on a 3-month basis. RESULTS: With a mean follow-up of 7.2 months(range 3 to 12), 61 women(98%) reported satisfaction (55 dry, 6 improved). Mean operative time was 72.5 minutes and mean hospital stay was 4.2 days. Mean postoperative catheter drainage was 5.4 days and 3 patients(5%) required prolonged catheter drainage, which required more than 2 weeks but no longer than 1 month. De novo urgency developed in 3(5%) patients. CONCLUSIONS: In situ anterior vaginal wall sling represents an effective, simple and safe option for the treatment of both anatomic incontinence and intrinsic sphincteric deficiency.

Anterior Vaginal Wall Sling Operation with Bone Fixation using Self-made Titanium Screw for Stress Urinary Incontinence Associated with Intrinsic Sphincter Deficiency / 대한비뇨기과학회지

PURPOSE: Anterior vaginal wall sling operation (by Raz`s method )for the treatment of stress urinary incontinence(SUI) associated with intrinsic sphincter dysfunction(ISD) may produce postoperative suprapubic discomfort and suture related problem such as pull-through and loosening. Stabilization of the bladder neck to the pubic bone decreases the tension placed on the anterior rectus fascia and lessens the possibility of suture-related pain and the risk of entrapment of ilioinguinal neve branches. At present, bone anchoring system is available in Korea but its cost sometimes limit the use of the kit. Therfore, we developed self-made titanium screw which is anchored to pubic bone at the time of anterior vaginal wall sling operation and acquired good short-term results. MATERIALS AND METHODS: Total 16 women who had SUI with ISD were treated by in-situ anterior vaginal wall sling using self-made titanium screw anchored to pubic bone to support the bladder neck and midurethra. Postoperative results were analyzed for 16 patients who has been followed up for more than 3 months after surgery. RESULTS: Overall cure rate was 100% at 3 months of follow-up. Complication included anemia in 2 patients, mild dysuria in 2 patients and osteitis pubis in 1 patient. After resting and antibiotic therapy, complications were subsided. CONCLUSIONS: In short term follow-up, anterior vaginal wall sling using self-made titanium screw was shown to be very effective treatment of SUI with ISD with simple technique and had relatively low cost, low complication rates. Long-term followup will be necessary to define the efficacy of this method.

Results of Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To review the short-term result of Raz`s anterior vaginal wall sling as a treatment for intrinsic sphincter deficiency(ISD) and urethral hypermobility. MATERIALS AND METHODS: Twenty-three women who had intrinsic sphincter deficiency and urethral hypermobility were treated by AVL which employed an island of in situ anterior vaginal wall as a sling to support the bladder neck and mid-urethra. RESULTS: After a mean follow-up of 4.7(3-6)months, urinary incontinence was disappeared completely after the AVL. Complications included urinary retention in 6 patients, residual urine sensation in 5 patients which improved after intermittent catheterization. The other complication was low abdominal pain in 5 patients. CONCLUSIONS: It is suggested that AVL was effective treatment of ISD and urethral hypermobility with simple technique, low morbidity and high cure rate.

Anterior Vaginal Wall Sling for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The vaginal wall sling was introduced by Raz as a simpler and lessmorbid alternative to fascial or synthetic slings for the treatment of female stress urinary incontinence. The purpose of this study was to determine the efficacy and safety of anterior vaginal wall sling in the management of women with anatomical incontinence(Al) and intrinsic sphincteric deficiency(ISD). MATERIALS AND METHODS: We performed vaginal wall sling on 46 consecutive women with stress incontinence. Preoperative evaluation included voiding cystourethrogaphy, urodynamic study, cystocsopy and incontinence staging with SEAPI classification. Postoperative subjective SEAPI outcome measures and assessment of complications were checked on a 3-month basis. RESULTS: Of the patients 19(49%) had Al and 27(59%) had ISD. Median follow-up was 8 months (range 6 to 10). Mean operation time was 65 minutes. At follow-up all of the patients reported no stress incontinence and 15% reported urge incontinence. De novo urge incontinence did not occur. Complications included prolonged voiding difficulty(8,7%), suprapubic pain(8.7%), and pain on leg abduction(4.3%). Four patients had a prolonged time to gain complete bladder emptying, which required more than 3 weeks to resolve. Permanent urinary retention has not occurred in any patient. CONCLUSIONS: Vaginal wall sling is a safe, simple and effective procedure for the treatment of stress urinary incontinence due to Al and ISD.

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Experience of Raz Transvaginal Bladder Neck Suspension and Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence and Cystocele / 대한비뇨기과학회지

PURPOSE: We retrospectively evaluated the 45 patients who underwent the original Raz procedure and anterior vaginal wall sling(AVWS) operation for stress urinary incontinence(SUI) with or without cystocele. MATERIALS AND METHODS: Transvaginal bladder neck suspension was performed in 14 patients, 4-corner bladder and bladder neck suspension in 16 patients, anterior vaginal wall sling in 14 patients, and 6-corner suspension in one patient. Of 16 patients who underwent 4-corner operation, 11 had grade 2 cystocele, and 5 had grade 3 cystocele. RESULTS: Mean age was 49 years and mean parity was 2.7. Duration of symptom was 58.5 months in average. Patients with grade l was 27%(12), grade ll was 69%(31) and grade lll was 4%(2). Mean operation times were 92. 1minutes in Raz bladder neck suspension, 90.9minutes in 4-corner bladder and bladder neck suspension, and 76.2minutes in anterior vaginal wall sling. The duration of follow up was 20 months in average. Urinary incontinence was completely disappeared in 40 patients(91%), and significantly improved in 3 patients(7%), but one patient(2%) underwent Raz BNS was recurred. Complications include a case of severe bleeding requiring intraoperative transfusion, 2 cases of prolonged retention, 2 cases of do novo urgency and 2 cases of persistent weak urinary stream. CONCLUSIONS: Our midterm result for Raz BNS and 4-corner operation was good(96.7%) and short term result for AVWS was excellent(100%). We think that original Raz BNS may be used in patients with mild SUI without ISD. And, long term follow-up for AVWS operation is required to determine persistence of the good results in patients with moderate to severe SUI.

Experience of Transvaginal Bladder Neck Suspension by Raz and Vaginal Wall Sling Operation for Female Stress Urinary Incontinence and Coexisting Cystocele / 대한비뇨기과학회지

Transvaginal bladder neck suspension(TVBNS) by Raz is an acceptable procedure for the treatment of stress urinary incontinence(SUI) with high cure rate, operative simplicity, short hospitalization and little morbidity. We had treated 89 patients of stress urinary incontinence with or without cystocele. Age of the patients ranged from 28 to 78 years(mean 47.7) and mean parity was 2.9. According to the symptom grading by Stamey, Grade 1 was 18.0%(16), Grade II was 79.8%(71) and Grade III was 2. 2%(2). Coexisting cystocele were 8 cases. TVBNS by Raz were undertaken for the 82 patients of Grade I and II SUI and also with coexisting Grade 1 cystocele, 4-corner bladder neck suspension were undertaken for the 3 patients of SUI with coexisting Grade II cystocele, and TVBNS with cystocele repair were undertaken for the 2 patients of SU with coexisting Grade III cystocele. For the 2 patients of total incontinence, vaginal wall sling operation were undertaken. Mean operation time for the cases treated by Raz procedures was 56.3+/-12.3 min.; whereas it was 98.3+/-25.3 min. for the cases with coexisting cystocele. Intra or post-operation blood transfusion was performed in 7 cases. Mean duration of hospital stay after Raz procedures were 4.5+/-0.9 days and 7.3+/-1.9 days for the treated by cystocele repair. Mean interval for returning to normal voiding after operation were 11.9+/-3.0 days after Raz procedures and 22.3+/-4.3 days after the correction of coexisting cystocele. Residual urine at discharge was less than 100 ml in 54 cases(60.7%). After the mean followup of 3.5 months, urinary incontinence was disappeared completely in 83 cases(93.3%). For the 2 cases of total incontinence, symptoms were disappeared completely after the vaginal wall sling operation. Complications included persistent voiding difficulty in 3 patients(improved after suspension take down in 2 cases and following up in 1 case), recurrence of urinary incontinence in 3 cases(which was disappeared by periurethral injection of collagen in 2 cases), frequency in 16 cases(improved by medication), bladder stone in 1 case(treated by cystolithorapaxy), and dyspareunia in 1 case. Conclusively, it could be suggested that the Raz procedures and vaginal wall sling operation are reliable techniques or the treatment of SUI and cystocele with little morbidity and high cure rate.