FAVORABLE OUTCOME OF PUBOVAGINAL SLINGS FOR GERIATRIC WOMEN WITH STRESS-INCONTINENCE

Purpose: Traditionally pubovaginal slings have been associated with a greater risk of immediate morbidity and prolonged voiding dysfunction compared to other stress incontinence repairs. Because elderly patient s already have inherently greater perioperative risk and prevalence of innate voiding dysfunction, there is some reluctance to construct sli ngs in this age group. We examined the outcome of pubovaginal sling in elderly women versus younger controls to determine whether this conce rn is justified. Materials and Methods: We retrospectively analyzed th e outcome of 19 geriatric women older than 70 years who underwent a pu bovaginal sling procedure between 1992 and 1995, and compared the find ings to those of 77 younger control women with a mean followup of 22 m onths. All women had video urodynamically proved stress incontinence d ue to intrinsic sphincter deficiency and many had coexistent bladder i nstability symptoms. Women with neurogenic causes for incontinence wer e excluded from the study. Results: Stress incontinence resolved in 10 0% of geriatric and 97% of control women, Preoperative instability sym ptoms, including urge incontinence, improved in more than 50% of patie nts in both groups. De novo instability symptoms arose in 10% of women in each group but were generally controlled with anticholinergics. Ef ficient voiding resumed within a mean of 16 days in both groups. Concl usions: The morbidity and success rates of pubovaginal sling surgery i n the elderly compare favorably to those in younger women. Advanced ag e alone would not dissuade us from constructing a pubovaginal sling wh en indicated.