Pubovaginal sling: 4-year outcome analysis and quality of life assessment

Purpose: Stress urinary incontinence is a common disease with a devastating impact on patient quality of life. Needle suspension procedures, which pro duce disappointing long-term results for type II stress incontinence, are b eing replaced by pubovaginal slings which previously were reserved solely f or the treatment of type III stress incontinence. We report the long-term o utcomes of pubovaginal slings for the treatment of types II and III stress urinary incontinence, and assess its quality of life impact. Materials and Methods: From January 1993 until December 1996, 247 females 1 0 to 84 years old (mean age 54.5) with type II (54%) or III (46%) stress ur inary incontinence diagnosed by fluoroscopic urodynamics received a pubovag inal sling. Concomitant urge incontinence was present in 109 patients (44%) . Quality of life was assessed with the Urogenital Distress Inventory short form. Results: At a mean followup of 51 months (range 22 to 68) the continence ra tes were 88% overall, 91% for type II and 84% for type III. Preoperative ur ge incontinence resolved in 81 of 109 patients (74%), while de novo urge in continence developed in 10 (7%). Intermittent urethral catheterization dura tion averaged 8.4 days, with 5 women undergoing urethrolysis for a hyper-su spended urethra. Secondary procedures were required in 9 patients with type II and 5 with type III incontinence, and included transurethral collagen i njections in 6 and repeat pubovaginal slings in 8. There was a 4% complicat ion rate due to pelvic hematoma in 2 cases, incisional hernia in 2, deep ve nous thrombosis in 1 and pulmonary embolus in 1. Of the 247 patients 235 (9 5%) completed the quality of life questionnaire with 92% reporting a high d egree of satisfaction with low (less than 20 of 100 points) symptom distres s scores. Conclusions: Pubovaginal slings are effective and durable, and significantl y improve quality of life in patients with types II and III stress urinary incontinence.