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The in situ anterior vaginal wall sling: predictors of success
H B Goldman1, R R Rackley, R A Appell
1Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Purpose:
We assessed the outcome of the in situ anterior vaginal wall sling for stress urinary incontinence, identified any predictors of success and reviewed the current literature on this topic.
Materials And Methods:
We identified all patients who underwent an isolated anterior vaginal wall sling procedure in a 16-month period. Charts were reviewed and telephone interviews were performed to assess the success rate of the procedure and identify parameters that may influence outcome. The pertinent literature was identified.
Results:
Of the 42 patients identified 39 had evaluable data available. The overall success rate was 79.5% at an average 19-month followup. Abdominal Valsalva leak point pressure 50 cm. water or greater was identified as a significant predictor of success (p = 0.002). The success rate was 93% and 40% in patients with a Valsalva leak point pressure of 50 or greater and less than 50 cm. water, respectively. The pertinent literature was reviewed.
Conclusions:
The anterior vaginal wall sling is effective for stress urinary incontinence. In patients with a Valsalva leak point pressure of 50 cm. water or greater the success rate is 93%. We recommend the anterior vaginal wall sling procedure in these patients but different treatment in those with Valsalva leak point pressure less than 50 cm. water.
