Fascial Mild Urethral Sling or Artificial Urinary Sphincter in the Neurological Women Population, a Multicenter Study

Achieving continence in patients with neurogenic bladder is a difficult goal especially when stress urinary incontinence (SUI) due to intrinsic sphincter deficiency is involved. Two techniques are commonly used in that setting, but they have never been directly compared: the artificial urinary sphincter (AUS) and the fascial pubovaginal sling (PVS). The present study aims to compare the outcomes of AUS and PVS in female neuropathic patients.

This retrospective international multicenter study was conducted from 2014 to 2023. We included all women with a past medical history of neurogenic bladder who underwent AUS or a PVS insertion (cadaveric or fascia lata) at three centers. The primary endpoint was the outcomes as assessed by the patient global impression of improvement (PGII) at 3 months and at the last follow-up.

Thirty-five patients were included: 16 with AUS and 19 with PVS. The PVS patients had fewer previous anti-incontinence procedures (10.5% vs. 43.8%; p = 0.02). The maximum cystometric capacity was significantly higher in the AUS group (364.1 vs. 252.8 mL; p = 0.03). All perioperative outcomes were similar in both groups with only two major postoperative complications in each group (12.5% vs. 10.5%; p = 0.99). Many functional outcomes favored AUS, but with no statistically significant difference, except for PGII = very much improved at 3 months (68.8% vs. 31.6%; p = 0.04).

AUS and PVS are two procedures yielding satisfactory outcomes in the female neurogenic SUI population, with similar morbidity. The functional outcomes may be more favorable with AUS.