| Abstract: |
This article reports on a study that assessed the results of pubovaginal sling surgery in women with simple stress urinary incontinence (SUI) using strict subjective and objective criteria. Simple incontinence was defined as sphincteric (bladder opening) incontinence with no concomitant urge incontinence, pipe stem or fixed scarred urethra, urethral or vesicovaginal fistula, urethral diverticulum, grade 3 or 4 cystocele, or neurogenic bladder. A total of 67 consecutive women (mean age 56 years plus or minus 11 years) who underwent pubovaginal sling surgery for simple sphincteric incontinence were prospectively followed for 12 to 50 months. Cure was defined as no urinary loss due to urge or stress incontinence, as documented by 24 hour diary and pad test, with the patient considering herself cured. Failure was defined as poor objective results with the patient considering surgery to have failed. Of the 67 patients, 46 (69 percent) had type II and 21 (31 percent) had type III incontinence. Preoperative diary and pad tests revealed a mean of 5.9 (plus or minus 3.6) stress incontinence episodes and a mean urinary loss of 91.8 grams (plus or minus 81.9 grams) per 24 hours. There were no major intraoperative, perioperative, or postoperative complications. Two patients (3 percent) had persistent minimal stress incontinence and 7 (10 percent) had new onset urge incontinence within 1 year after surgery. Overall using the strict criteria of the outcome score, 67 percent of the cases were classified as cured, and the remaining 33 percent were classified as improved. The degree of improvement was defined as a good, fair, and poor response in 21 percent, 9 percent, and 3 percent, respectively. Midterm outcome results defined by strict subjective and objective criteria confirm that the pubovaginal sling is highly effective and safe surgery for simple sphincteric incontinence. A followup of more than 5 years is required to establish the long term durability of this procedure. 2 tables. 11 references. |