Results of pubovaginal sling for stress incontinence: A prospective comparison of 4 instruments for outcome analysis

Purpose: Presently to our knowledge there are no standardized techniques to assess outcomes after surgery for stress incontinence. We performed a pros pective blinded study to assess the correlation among physician and patient assessments, and a validated 24-hour pad test and voiding diary. Materials and Methods: A total of 84 women were evaluated before and after pubovaginal sling for stress incontinence with a voiding diary, pad test an d symptom questionnaire (patient assessment) administered by a blinded thir d party. The operating surgeon evaluated the patient using history, physica l examination, pad test and voiding diary but was blinded to results of the outcome questionnaire. Preoperative focused neurourological examination an d video urodynamics confirmed stress incontinence. Patients were assessed a t least 1 year postoperatively, We compared patient assessment (cured, impr oved, failure) to the outcome of the pad test, voiding diary and physician assessment. The physician and questioner were blinded to each other. We con sidered patients with a pad test of 0 to 2 ml. as cured, 50% or more volume reduction as improved and less than 50% volume reduction as failure. Posto perative assessment did not differentiate between stress and urge incontine nce. The kappa coefficient was used for statistical comparison. Results: Average patient age was 58 years and average followup for the enti re group was 4 years. Agreement among the 4 instruments to assess outcome w as excellent (k >0.9) with respect to cured/improved versus failure but onl y good for cured versus improved versus failure (k >0.5). Conclusions: Outcomes following incontinence surgery may vary depending on how the analysis was performed, patient selection, definition of success an d so forth. Our results indicate that a pad test and voiding diary are reli able and should be part of the normal followup after pubovaginal sling for sphincteric incontinence. When these tests are used in conjunction with def ined parameters of success, there is excellent agreement with patient feeli ngs in regard to success or failure of surgery. Nevertheless, these instrum ents and methods are imperfect at best.