Modified pubovaginal sling for treatment of intrinsic sphincteric deficiency

We report on 63 women undergoing modified pubovaginal fiscal sling construction for treatment of intrinsic sphincteric deficiency. We specifically evaluated duration of postoperative urinary retention, persistence of urinary incontinence and incidence of detrusor instability.

Preoperative questionnaires, fluoro-urodynamic studies, hospital and clinical records, and postoperative questionnaires were reviewed to assess comparative outcome among the patients. Failed procedures were studied with fluoro-urodynamics. Patient follow up ranged from 3 to 27 months (mean 11.7).

Of the 63 patients 2 (3.2%) remained in long-term urinary retention, 4 (6.3%) had persistent stress incontinence and 3 (4.8%) had long-term detrusor instability. Two patients (3.2%) required reoperation for relief of persistent urinary retention (1) and for repair of anteriorly disrupted suspensory sutures (1). Review of preoperative fluoro-urodynamic studies did not provide insight into patients who would experience the aforementioned outcomes.

Our study confirmed the success of the modified pubovaginal fascial sling for treatment of intrinsic sphincteric deficiency. We were unable to obtain useful preoperative information from fluoro-urodynamic studies to predict which patients would experience failure to return to normal voiding.