Long-term follow-up of porcine dermis pubovaginal slings.

INTRODUCTION AND HYPOTHESIS: Outcomes of xenografts in incontinence surgery are uncommon. Our objective was to report long-term outcomes of women after porcine dermis (PD) bladder neck sling. METHODS: Seventy women completed a mean follow-up of 62.1 months. "Global cure" equaled SEAPI subjective composite = 0 and visual analog score ≥8. "Stress urinary incontinence (SUI) cure" equaled SEAPI-subjective (S) subset = 0 and negative cough stress test. RESULTS: The SUI cure rate was 42.9 % and global cure rate was 11.4 %. Perioperative complications were seen in <10 % of women. The mean time to SUI recurrence was 10.4 months, with 30 of 40 women redeveloping SUI <12 months after sling. Twenty women (28.6 %) have since undergone additional anti-incontinence procedures. There was a significant postoperative improvement in SEAPI scores, daily pad use, and quality of life (QOL) indices. CONCLUSIONS: At long-term follow-up, PD is not a durable material in sling surgery. Although QOL generally improves after surgery, most SUI recurrences occurred soon after surgery.

Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women?

PURPOSE: Obese women (body mass index 30 kg/m2 or greater) are considered to be at risk for postoperative complications and failure after stress incontinence surgery. We compare the outcomes in this population with nonobese women (body mass index less than 30 kg/m2) undergoing rectus fascia, porcine dermis and polypropylene sling procedures. MATERIALS AND METHODS: We retrospectively identified 412 women with a body mass index less than 30 kg/m2 (94 autologous rectus fascia, 157 acellular porcine dermis, 161 transobturator polypropylene mid urethral sling) and 297 with a body mass index of 30 kg/m2 or greater (66 autologous rectus fascia, 114 acellular porcine dermis, 117 transobturator polypropylene mid urethral sling) who underwent sling procedures and other pelvic surgery. Evaluation included SEAPI assessment and quality of life questionnaires. Global cure equaled subjective SEAPI composite=0 and subjective satisfaction. Stress urinary incontinence cure equaled SEAPI (S)=0 and negative cough stress test. Chart review for perioperative data was conducted. Groups and outcomes were statistically compared. RESULTS: All women had a minimum followup of 12 months. After controlling for body mass index preoperative demographics, SEAPI scores and quality of life indices were not statistically different within each sling group. Global cure and stress urinary incontinence cure rates were significantly higher for nonobese women in each sling group. Statistically significant improvement in SEAPI scores and quality of life indices was achieved for all groups, and there were no statistical differences within each sling group. Overall obese women had no increase in complications compared with nonobese women. The incidence of obstructive sequelae was statistically higher in nonobese women undergoing autologous rectus fascia and transobturator polypropylene mid urethral sling procedures. CONCLUSIONS: Although cure rates are lower, obese women have significant improvements in quality of life after surgery for stress urinary incontinence. Obesity does not appear to be a risk factor for additional complications during sling and prolapse surgery.

Incidence and management of vaginal extrusion of acellular porcine dermis after incontinence and prolapse surgery.

We report our experience with vaginal extrusion of acellular porcine dermis in women undergoing pelvic reconstructive surgery. Over 5 years, 270 patients received a Pelvicol pubovaginal sling (PVS) or prolapse repair using interposition graft. Charts were retrospectively evaluated for evidence of graft extrusion, management, and outcomes. Chi-square analysis was conducted to evaluate the association of extrusion with perioperative variables. Nineteen women (7%) had partial or complete vaginal graft extrusion. After a PVS, 11 of 13 women healed by re-epithelialization and remained continent, while 2 required operative debridement. Four of six patients receiving interposition grafts healed after small incisional separations. Two women underwent additional surgery to address extensive extrusion, and both prolapses recurred. After statistical analysis, vaginal extrusion was significantly associated with PVS and concomitant urethral diverticulectomy. Small incisional separations frequently heal and cause no symptom recurrence. Larger areas of extrusion may require debridement and may contribute to recurrence of symptoms.

Transvaginal ultrasound for the diagnosis of urethral diverticulum.

PURPOSE: We reviewed our experience with urethral diverticula and transvaginal ultrasound to evaluate female patients with this condition. MATERIALS AND METHODS: All female patients who underwent transvaginal ultrasound during evaluation for urethral diverticulum at our institution between May 1995 and April 2002 were identified by searching a data base. We reviewed the diagnostic evaluation and compared diagnostic techniques with transvaginal ultrasound for diagnosing urethral diverticulum. RESULTS: Of the 25 patients with suspected urethral diverticulum who underwent transvaginal ultrasound as a diagnostic procedure 10 (40%) were diagnosed with urethral diverticulum, including 10 in whom it was confirmed by surgery or other diagnostic procedures. Transvaginal ultrasound was less expensive than the other diagnostic modalities and in no case did it miss a urethral diverticulum that was identified by another diagnostic technique. Urethral diverticulum was detected on 1 of 3 voiding cystourethrograms (33%) and this study missed the diagnosis in 1 case that was diagnosed by transvaginal ultrasound. Three cases of urethral diverticulum were noted on transvaginal ultrasound after they were missed by cystoscopy. Videourodynamics were unable to diagnose urethral diverticulum. CONCLUSIONS: Transvaginal ultrasound is effective for evaluating patients with suspected urethral diverticulum. It is less expensive and may identify diverticula missed by other diagnostic modalities.