VAGINAL WALL SLING - LONG-TERM OUTCOME ANALYSIS OF FACTORS CONTRIBUTING TO PATIENT SATISFACTION AND SURGICAL SUCCESS

Purpose: The clinical outcome of the vaginal wall sling was retrospect ively evaluated to determine patient perception, satisfaction and fact ors contributing to postoperative success. Materials and Methods: An o utcome based study was conducted of 51 patients undergoing constructio n of a vaginal wall sling for genuine stress incontinence or intrinsic sphincteric deficiency. Preoperative symptoms, demographic parameters and video urodynamic studies were correlated with postoperative patie nt perception of symptoms to determine patient satisfaction and factor s contributing to overall success. Results: Of 42 patients (82%) avail able for followup 31 (74%) reported improvement in continence, 26 (62% ) are currently satisfied with the urinary status, 72% in retrospect w ould repeat the procedure and 69% would recommend the vaginal wall sli ng to others. Despite long-term resolution of stress incontinence in 9 2% of those with genuine stress incontinence and 75% with intrinsic sp hincter deficiency, postoperative urge incontinence was the single mos t important factor affecting patient satisfaction (p = 0.001), Patient s without postoperative urge incontinence enjoyed the greatest levels of satisfaction, in excess of 90% (p = 0.001). Although preoperative l eak point pressure correlated with resolution of stress incontinence, no preoperative demographic factors, symptoms or urodynamic parameters could reliably predict postoperative patient satisfaction. Conclusion s: The vaginal wall sling represents an excellent option for the treat ment of genuine stress incontinence and an acceptable option for intri nsic sphincteric deficiency. Patient perception and satisfaction remai n closely associated with presence or resolution of postoperative urge incontinence. However, prediction of postoperative urge incontinence remains a challenge and should be considered when counseling patients preoperatively.