Prospective analysis of 373 consecutive women with stress urinary incontinence treated with a vaginal wall sling: The Columbia-Cornell University experience

Purpose: We compare the efficacy and morbidity of 373 consecutive women who underwent a vaginal wall sling for stress urinary incontinence due either to anatomical incontinence or intrinsic sphincter deficiency. To our knowle dge this series is the largest prospective database on surgical management of stress urinary incontinence in the urological literature. Materials and Methods: Preoperative evaluation included history, voiding di ary, physical examination, cystoscopy, pad count and video urodynamic study . Outcome measures included postoperative presence of incontinence secondar y to either stress and/or detrusor instability, number of pads used, compli cations, operating time, length of suprapubic catheterization, length of ho spitalization and loss of work days. Results: A total of 373 consecutive women 18 to 85 years old (mean age 55.7 ) were followed for a mean of 39.8 months. Of these patients 183 (49%) pres ented with anatomical incontinence and the remaining 190 (51%) had intrinsi c sphincter deficiency. Preoperative detrusor instability was present in 60 (33%) patients with anatomical incontinence and 68 (36%) with intrinsic sp hincter deficiency. Postoperatively, 14 patients (4%) had recurrent stress urinary incontinence. De novo detrusor instability and urge incontinence we re noted in 30 women (8%), and was persistent in 22 (6%). There was no corr elation between the diagnosis of anatomical incontinence or intrinsic sphin cter deficiency and persistent stress urinary incontinence or detrusor inst ability. Daily pad use was decreased from 4.3 to 0.5 and from 4.6 to 0.4, r espectively, for patients with anatomical incontinence and intrinsic sphinc ter deficiency. Operating time, catheter duration, length of hospital stay and days lost from work for patients with anatomical incontinence (33.3 +/- 14.3 minutes, 4.7 +/- 1.1 days, 0.9 +/- 0.7 days and 11.3 +/- 2.9 days, re spectively) were similar to patients with intrinsic sphincter deficiency (3 8.4 +/- 17.8, 4.6 +/- 0.9, 1.1 +/- 0.7, 12.4 +/- 4.7). The most common comp lications were urinary tract infection (3%), wound infection (4%) and pelvi c organ prolapse (7%). Conclusions: The results of this large database suggest that the vaginal wa ll sling is effective for the management of stress urinary incontinence. Ef ficacy, morbidity and reduced hospitalization time were similar for patient s with either anatomical incontinence or intrinsic sphincter deficiency and independent of surgeon experience.