TREATMENT OF STRESS URINARY-INCONTINENCE IN WOMEN WITH URETHRAL HYPERMOBILITY AND INTRINSIC SPHINCTER DEFICIENCY

Purpose: We compared 2 treatment modalities (sling cystourethropexy an d periurethral collagen injection) in patients with intrinsic sphincte r deficiency alone or with urethral hypermobility (combined stress uri nary incontinence). Materials and Methods: We retrospectively reviewed a series of 50 consecutive patients treated surgically for intrinsic sphincter deficiency during a 2-year period. All patients were evaluat ed by history and physical examination to assess urethral hypermobilit y and urodynamic testing. Intrinsic sphincter deficiency was assessed by abdominal leak point pressure and video urodynamics. Of the 50 pati ents 28 underwent a pubovaginal sling operation and 22 received a peri urethral injection of collagen. Results: Of the patients studied 40% h ad combined stress urinary incontinence. A pubovaginal sling procedure resulted in a cure rate of 81% in this group, compared to 25% for per iurethral injection of collagen. Conclusions: A subgroup of women exis ts with combined stress urinary incontinence due to urethral hypermobi lity and intrinsic sphincter deficiency. When treated with sling cysto urethropexy women with combined stress urinary incontinence do as well or better than those with intrinsic sphincter deficiency alone and th ose treated with periurethral collagen injection do worse.