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Is the anterior vaginal wall sling a good alternative for intrinsic sphincteric insufficiency?
Paulo C R Palma1, Cassio L Z Riccetto, Aderivaldo C Dias Filho
1Division of Urology, School of Medicine, State University of Campinas, SP, Brazil.
Objectives:
We present our experience with the anterior vaginal wall sling, in the treatment of patients with stress urinary incontinence (SUI) due to urethral intrinsic sphincteric deficiency.
Material And Methods:
Forty-five women (mean age 53.4 years) with urodynamically proven intrinsic sphincteric deficiency (Valsalva Leak Point Pressure below 60cm H(2)O) were studied, prospectively. Coexisting bladder neck hypermobility was assessed using transperineal ultrasound. Patients with severe pelvic prolapse (grade 3 or 4) were excluded. Multivariable logistic regression was used to identify the variables that influenced the outcome (statistical significance was established for p<0.05). Follow-up ranged from 26 to 61 months (mean 40 months).
Results:
Complete SUI cure was achieved in 14 women (31.1%) and 17 other women (37.8%) described SUI improvement and were satisfied with the outcome. Statistical analysis showed that factors such as age below 35 years (p=0.0251), and preoperative bladder neck hypermobility (p=0.0176), were strongly related to postoperative continence.
Conclusions:
We concluded that the vaginal wall sling has a high rate of failure in the treatment of patients with intrinsic sphincteric deficiency. This technique should not be proposed if hypermobility is not associated, especially in the case of elderly patients.
