Ca. Cross et al., TREATMENT RESULTS USING PUBOVAGINAL SLINGS IN PATIENTS WITH LARGE CYSTOCELES AND STRESS-INCONTINENCE, The Journal of urology, 158(2), 1997, pp. 431-434
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.