Predictors of outcome after in situ anterior vaginal wall sling surgery

Pubovaginal sling procedures are being performed with increased frequency for stress urinary incontinence. The vaginal wall sling was introduced in 1989 by Raz et al., and its success rate has been reported as being 61%-100%. A number of recent studies have identified that some patient factors may influence the likelihood of a successful outcome. In the present study, we evaluated whether preoperative Valsalva leak-point pressure and urethral pressure profile can be used as predictors of success after surgery. We identified the preoperative characteristics of 58 women who underwent an isolated in situ anterior vaginal wall sling procedure by the same surgeon. Patients' ages, previous anti-incontinence procedures, hormone replacement status and previous hysterectomies were determined and patients underwent urodynamics, including cystometry, measurement of the Valsalva leak-point pressure and urethral pressure profile (maximal urethral pressure). After the vaginal wall sling procedure, success was defined as a significant improvement in stress urinary incontinence symptoms or no symptoms at all. The 58 women ranged from 41 to-71 years old (average 52.3) and average follow-up was 26 months (range 16-34). An anti-incontinence procedure had been done previously in 15% of cases. The success rate was 65.4% in patients with Valsalva leak-point pressure < 50 cmH2O and maximal urethral pressure < 30 cmH2O, but it was 90.6% in patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more. Patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more had a 90.6% success rate, and it was significantly higher than the success rate of patients with lower values for both parameters. We concluded that preoperative Valsalva leak-point pressure and maximal urethral pressure can be used to estimate the success rate of anterior vaginal wall sling procedures. When of these parameters are concurrently high, the outcome of surgery seems more favorable.