TREATMENT RESULTS USING PUBOVAGINAL SLINGS IN PATIENTS WITH LARGE CYSTOCELES AND STRESS-INCONTINENCE

Purpose: We determined the efficacy of performing a pubovaginal sling concurrently with a formal cystocele repair in patients with grade III to IV cystoceles. Materials and Methods: We studied 42 women with gra de III to IV cystoceles diagnosed by physical examination and video ur odynamics. Of the patients 9 (22%) had intrinsic sphincter deficiency diagnosed by an abdominal leak point pressure of less the 60 cm. water , and 24 (57%) had type II stress incontinence with urethral hypermobi lity and an abdominal leak point pressure greater than 90 cm. water. A pubovaginal sling and anterior colporrhaphy were performed and, if in dicated, other vaginal procedures were done at that time. Results: A t otal of 36 patients (86%) was available for postoperative pelvic exami nations performed at 3-month intervals, for a mean followup of 20.4 mo nths (range 12 to 39). Only 3 patients had symptomatic grade III cysto celes and 2 had enteroceles. Two patients required collagen injections and 2 underwent a repeat pubovaginal sling. Therefore, all patients w ere continent at the time of followup, Conclusions: This study confirm s that in patients with large cystoceles and stress urinary incontinen ce a pubovaginal sling and anterior colporrhaphy effectively treat the incontinence and reduce the cystocele. In addition, the fascial sling appears to provide additional support to the bladder base, improving the durability of the anterior colporrhaphy.