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.

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.