Modified Pereyra bladder neck suspension in patients with intrinsic sphincter deficiency and bladder neck hypermobility: Patient satisfaction with a mean follow-up of 4 years

Objectives. To determine the long-term success rate for the modified Pereyr a bladder neck suspension and to identify preoperative characteristics that create differences in surgical outcome. We attempted retrospectively to se parate those patients with what we now recognize was significant intrinsic sphincter deficiency (ISD) before routine use of Valsalva leak point pressu res (VLPPs) was available. Methods. The charts and videourodynamic reports of 208 patients who underwe nt a modified Pereyra bladder neck suspension from June 1988 to June 1996 w ere reviewed, and survey questionnaires were mailed to all patients. Ail vi deourodynamic study reports and charts were reviewed to identify those with what we now recognize was significant ISD and compare them with a group th at we believed had more pure descent problems. Results. A total of 135 patients or 65% of the population responded. The me an time after surgery was 4.14 years. At the follow-up survey, 14% reported no leakage at all, 42% reported very little or mild leakage, 38% reported moderate leakage, and 6% reported severe leakage. Fifty-three percent of pa tients continued to wear pads. Seventy-nine percent reported improvement in their leakage compared with the preoperative state, and 69% were satisfied with the results. When patients with preoperative ISD were compared with p atients with pure bladder neck hypermobility, the ISD group had more leakag e and less improvement after surgery than patients with bladder neck hyperm obility. Conclusions. With an average follow-up of greater than 4 years, most women continued to leak with symptoms of stress urinary incontinence. Even though 79% reported improvement over their preoperative condition and 69% were sa tisfied, the results were disappointing. Patients with significant ISD had a worse outcome (2.6% dry) than patients with pure bladder neck hypermobili ty (20% dry). Given the above data, significant ISD is a contraindication f or a modified Pereyra transvaginal needle suspension, and these data cast f urther doubt on the ability of the modified Pereyra needle suspension to co nsistently cure even anatomic incontinence. (C) 2000, Elsevier Science Inc.