LONG-TERM CLINICAL AND URODYNAMIC EVALUATION OF THE POLYTETRAFLUOROETHYLENE SUBURETHRAL SLING FOR TREATMENT OF GENUINE STRESS-INCONTINENCE

Objective: To assess long-term clinical and urodynamic outcomes of sub urethral sling procedures using polytetrafluoroethylene grafts. Method s: Between January 1986 and May 1991, 108 women underwent suburethral sling placement to treat genuine stress incontinence. At least 1 year after surgery, 62 women participated in a telephone interview about su rgical outcome and completed a follow-up urodynamic evaluation. Result s: Seventy-three percent of patients reported stress incontinence cure and 61% were objectively cured. Neither low urethral closure pressure nor a history of multiple prior anti-incontinence procedures, singly or in combination, adversely affected outcome. Postoperative maximum u rethral closure pressure and functional urethral length were significa ntly greater in patients who were cured of their incontinence than in those whose surgery failed. Patients who were cured had higher amplitu de detrusor contractions during micturition and greater post-void resi dual urine than those who were not cured. Thirty-three percent of pati ents with urodynamically stable bladders preoperatively developed detr usor instability after surgery. Detrusor instability remitted after su rgery in half of the patients who had this condition preoperatively. P ostoperative wound complications developed in 40% of patients who unde rwent sling placement, and 22% of the grafts were eventually removed. Conclusion: Polytetrafluoroethylene suburethral sling placement is an effective treatment for stress incontinence and low urethral pressure. Urodynamic data suggest that urethral obstruction is responsible for surgical cure. Patients should be warned of the high complication rate for this suburethral sling procedure and that graft removal may be ne cessary.