Long term follow up of the cruciate fascial sling for women with genuine stress incontinence

Abstract

Objective To determine the long term success of the cruciate fascial sling procedure for the treatment of genuine stress incontinence in women. Design In 1998, a pre-validated questionnaire was sent to all women who had a cruciate fascial sling between 1979 and 1996 under the care of the senior author at a District General Hospital and in private practice. Participants Questionnaires were sent to 246 women; 198 (80%) were returned.Results Overall, 142 women felt that they were much improved or cured. The success rate was 74% (95% CI 70% -81%) in women having the sling as a primary procedure and 67% (95% CI 54% -81%) in women having the sling as a secondary procedure. There was no relationship between symptom severity score and age at time surgery, duration of follow up, current weight or body mass index, previous surgery for stress incontinence or concomitant surgery. Of the 103 women with six or more years of follow up, 29 felt that their operation had failed, 16 of whom thought that it lasted between five and 10 years. Urgency was experienced by 29% of women, three needed to perform intermittent self-catheterisation, and 9% found it difficult to empty their bladder. Thirty-seven women (19%) experienced problems that they attributed to the abdominal wound. Conclusion Although inevitably there are some failures over time, the cruciate fascial sling has good long term success rates. Direct comparison with the literature is impossible, as few studies have relied on properly validated questionnaires.