Pubovaginal sling surgery for simple stress urinary incontinence: Analysisby an outcome score

Purpose: We assessed the results of pubovaginal sling surgery in women with simple stress urinary incontinence using strict subjective and objective c riteria. Materials and Methods: Simple incontinence was defined as sphincteric incon tinence with no concomitant urge incontinence, pipe stem or fixed scarred u rethra, urethral or vesicovaginal fistula, urethral diverticulum, grade 3 o r 4 cystocele, or neurogenic bladder. A total of 67 consecutive women with a mean age plus or minus standard deviation of 56 +/- 11 years who underwen t pubovaginal sling surgery for simple sphincteric incontinence were prospe ctively followed for 12 to 60 months (mean 33.9 +/- 23.2). Treatment outcom es were classified according to a new outcome score. Cure was defined as no urinary loss due to urge or stress incontinence, as documented by 24-hour diary and pad test, with the patient considering herself cured. Failure was defined as poor objective results with the patient considering surgery to have failed. Cases that did not fulfill these cure-failure criteria were co nsidered improved and further classified into a good, fair or poor response . Results: Of the 67 patients 46 (69%) had type II and 21 (31%) had type III incontinence. Preoperative diary and pad tests revealed a mean of 5.9 +/- 3 .6 stress incontinence episodes and a mean urinary loss of 91.8 +/- 81.9 gm . per 24 hours. There were no major intraoperative, perioperative or postop erative complications. Two patients (3%) had persistent minimal stress inco ntinence and 7 (10%) had new onset urge incontinence within 1 year after su rgery. Overall using the strict criteria of our outcome score 67% of the ca ses were classified as cured and the remaining 33% were classified as impro ved. The degree of improvement was defined as a good, fair and poor respons e in 21%, 9% and 3% of patients, respectively. Conclusions: Mid-term outcome results defined by strict subjective and obje ctive criteria confirm that the pubovaginal sling is highly effective and s afe surgery for simple sphincteric incontinence. A followup of more than 5 years is required to establish the long-term durability of this procedure.