In situ slings with concurrent cystocele repair

Stress urinary incontinence (SUI) is commonly associated with varying degrees of genitourinary prolapse; therefore, it is customary to perform surgical corrections of both problems simultaneously. The type of surgical correction is based on the surgeon's discretion. We present a series of patients who underwent in situ vaginal wall slings as well as anterior vaginal wall (cystocele) repairs. Eighteen patients treated between 1994 and 1998 were evaluated. The average age was 61 years (range 35 to 74). Urodynamic evaluation was performed preoperatively. Postoperatively, the patients were assessed with objective testing as well as physician-performed Medical, Epidemiologic, and Social Aspects of Aging questionnaires. Follow-up ranged from 6 months to 4 years. SUI cure was defined as a patient who is completely dry and voiding. Sixteen (89%) of 18 patients were cured of both their cystocele and SUI; 2 of 18 had recurrent SUI with no evidence of recurrent cystocele. Fifty-six percent of the patients with good results had preoperative leak point pressures (LPP) of 50 to 100, and 44% had LPP > 100. None of the patients who were cured had an LPP <50, and only one patient in the failure group had an LPP <50. Seventeen percent of the patients had de novo urgency. In situ vaginal wall slings are a good procedure to use in combination with cystocele repairs in patients with LPP >50.