Initial experience with the modified vaginal wall sling in the treatment of female stress urinary incontinence

From March 1995 to March 1996 24 women aged 29-73 years with stress urinary incontinence underwent a modified vaginal wall sling procedure following videourodynamic evaluation. Of these 24, 2 had stress urinary loss due to urethral hypermobility (UH), 3 had intrinsic sphincter deficiency (ISD) and 19 had both UH and ISD. Thirteen (54%) had preoperative urge incontinence, 13 (54%) had associated pelvic floor weakness, including cystocele, and 12 (50%) had had previous pelvic surgery and bladder neck suspension. Twenty-two patients were evaluable for a mean follow-up of 14 months (range 9-21 months). Stress urinary incontinence was resolved in all patients (100%). Of the patients with preoperative urge symptoms, 58% reported resolution but in 42% the urge symptoms remained unresolved. One new patient developed urge and occasional urge incontinence. Out of 22 patients 20 (90.9%) are totally continent; 2 (9.1%) are incontinent and both have documented detrusor instability and occasionally wear pads. The vaginal wall sling is an ideal procedure for the treatment of the various forms of stress urinary incontinence in women. In our series the early results indicate excellent patient acceptability and continence. Long-term follow-up will determine the durability of the procedure.