Pubovaginal Sling: 4-Year Outcome Analysis and Quality of Life Assessment

Morgan, Ted O.; Westney, O. Lenaine; McGuire, Edward J.

doi:10.1016/s0022-5347(05)67557-x

Cited by 197 publications

(84 citation statements)

References 19 publications

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“…In these cases, the patient should be alerted before surgery that the urethral perforation might need to be closed, with or without a Martius flap, The development of SUI after sling transection can be treated with a new AS (our preference) or NAS sling. If a new sling is used in these fixed 'pipe-stem' urethras, material near the bladder neck rather that at the midurethra would be necessary [10]. The present patients operated on with such a technique might require IC for vesical emptying and should be alerted to this risk before surgery.…”

Section: Discussionmentioning

confidence: 89%

“…However, in a tertiary-care referral centre, we have noted a increased incidence of complications, particularly in women with symptoms of obstruction or bladder irritability. In particular, there have also been more patients with vaginal erosion than with previous experience related to AS [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Three women with disabling SUI were treated with a new highly positioned (proximal to the bladder neck) but loosely tied pubovaginal sling from autologous tissue [10]. Two women with no obstruction but with severe urgency and frequency were referred for pelvic floor therapy (one) and neurostimulation (one).…”

Section: Methodsmentioning

confidence: 99%

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Disabling complications with slings for managing female stress urinary incontinence

et al. 2008

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OBJECTIVETo report an increase in the referral of patients with disabling complications after the failure of conservative therapy, their presentation, final surgical management and clinical outcome, following the use of non‐autologous slings (NAS), currently the primary surgical procedure for managing stress urinary incontinence (SUI) in women.PATIENT AND METHODSThirty‐eight patients (mean age 64 years) required surgical management for disabling complications after placing a NAS for SUI. Sling types were synthetic (25), xenografts (six) and allografts (four). Twenty (53%) patients presented with bladder outlet obstruction, 13 (34%) with sling erosion, three (8%) with worsened SUI, and two (5%) with unobstructive severe urgency and frequency.RESULTSThe sling was dissected and incised with no complication in 19 of 20 patients. One had a posterior urethral defect during sling dissection. Twelve patients (60%) acquired normal voiding and were continent. Among the 13 patients who had the sling dismantled and urethrolysis, two had recurrent or persistent SUI, two de‐novo urgency/frequency and one developed osteitis pubis. Three patients with disabling SUI received a pubovaginal sling placed proximal to the bladder neck, and had an overall improvement in their urinary control with no retention. Two unobstructed patients with urgency and frequency did not improve with anticholinergic medication and pelvic floor therapy, and are now candidates for botulinum toxin injection or neurostimulation.CONCLUSIONSThe complication rate with periurethral NAS for managing SUI in females is substantial. Patients with refractory urgency/frequency after the sling need a complete evaluation with cystoscopy and video‐urodynamics. Obstruction and erosion are the commonest problems and require surgical correction.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Disabling complications with slings for managing female stress urinary incontinence

et al. 2008

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“…This procedure provides an excellent success rate and minimal surgical morbidity. [1][2][3] However, a few patients might have persistent SUI, and some have de novo urgency or urge incontinence after surgery. [4][5][6] Among the patients with surgical failure, bladder outlet obstruction is the most common cause of failure, especially in patients who have an acontractile bladder due to previous radical hysterectomy or large cystocele.…”

mentioning

confidence: 99%

“…18 The pubovaginal sling procedure using either autologous fascia or synthetic material has gained popularity in recent years to treat all types of SUI. [1][2][3][4][5]19,20 However, the incidence of de novo detrusor instability remains a problem to be solved. In the classic pubovaginal sling procedure, Chaikin et al 3 and Cross et al 4 addressed the idea that the sling should be tied with minimal tension at the bladder neck to prevent iatrogenic bladder outlet obstruction.…”

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confidence: 99%

Sonographic evaluation of anatomic results after the pubovaginal sling procedure for stress urinary incontinence.

Kuo

2001

J of Ultrasound Medicine

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Objective. To investigate the anatomic changes after the pubovaginal sling procedure in women with stress urinary incontinence by transrectal sonography. Methods. This study enrolled 56 women with varying types of stress urinary incontinence who were treated with the pubovaginal sling procedure using self-fashioned polypropylene mesh. The suburethral sling was fixed without tension and was placed at the position between the bladder neck and the proximal urethra. The patients were investigated preoperatively and postoperatively by transrectal sonography of the bladder and urethra. Results. At a median follow-up of 24 months (range, 6-39 months), 48 patients (85.7%) were cured, 6 (10.7%) had improved, and 2 (3.6%) had treatment failures. Transrectal sonography revealed a wellsuspended bladder neck and proximal urethra in all patients who were cured. As measured by changes of the axis of the pubovesical ligament, the position of the bladder neck was elevated by a mean of 29.6 ± 21.5°in the resting condition and 47.4 ± 27.7°in the straining condition. An incompetent bladder neck and proximal urethra were noted in 8 patients who had stress urinary incontinence after surgery. The incidence of opening of the bladder neck was 84.6% in 13 patients with de novo urgency or urge incontinence, whereas only 2 (4.7%) of 43 patients who did not have postoperative urgency had opening of the neck (P = .000). Conclusion. Transrectal sonography provides useful information about anatomic changes after the pubovaginal sling procedure. Bladder neck incompetence after surgery was closely related to postoperative urgency or urge incontinence.

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The Ageing Bladder

Cummings

Berni

2012

Pathy's Principles and Practice of Geriatric Medicine

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Pubovaginal Sling: 4-Year Outcome Analysis and Quality of Life Assessment

Abstract: Pubovaginal slings are effective and durable, and significantly improve quality of life in patients with types II and III stress urinary incontinence.

Cited by 197 publications

References 19 publications

Disabling complications with slings for managing female stress urinary incontinence

Disabling complications with slings for managing female stress urinary incontinence

Sonographic evaluation of anatomic results after the pubovaginal sling procedure for stress urinary incontinence.

The Ageing Bladder

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