Five Year Follow-up Results of the Pubovaginal Fascial Sling Surgery in the Female Stress Urinary Incontinence

Seong Min So; Chong Koo Sul; Yong Gil Na

doi:10.4111/kju.2007.48.2.183

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So, Sul, and Na: Five Year Follow-up Results of the Pubovaginal Fascial Sling Surgery in the Female Stress Urinary Incontinence

Original Article

Korean J Urol 2007;48(2):183-188.

Published online: 18 December 2007

DOI: https://doi.org/10.4111/kju.2007.48.2.183

Five Year Follow-up Results of the Pubovaginal Fascial Sling Surgery in the Female Stress Urinary Incontinence

Seong Min So, Chong Koo Sul, Yong Gil Na

¹From the Department of Urology Chungnam National University College of Medcine, Daejeon Korea

Corresponding Author: Na Yong-gil Chungnam National University College of Medicine Department of Urology 640 Daesa-dong, Jung-gu, Daejeon 301-721 TEL: 042-220-7778 FAX: 042-257-0966 E-mail: yongna@cnu.ac.kr

Received 14 September 2006 Accepted 29 December 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

lunHH The long term results of pubovaginal fascial sling surgery were evaluated in female stress urinary incontinence (SUI), and were compared with concomitant surgery in pelvic organ prolapse.

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A total of 47 SUI patients were treated with pubovaginal fascial sling surgery between 1997 and 2000. A satisfaction evaluation and success grading of the operation were studied. A postoperative evaluation was performed via a survey questionnaire, uroflow- metry and post-void residuals.

Results:

RHuHH Forty-five patients (95.7%) showed successful results at the 2- & 5-year follow-ups, but 2 patients (4.3%) railed. There were no significant differences in success rates according to Valsalva leak point pressure (VLPP) and the pelvic organ prolapse surgery. Thirty-one patients (66.0%) were satisfied with their result, while 16 (34.0%) were unsatisfied at the 2-year follow up. Those unsatisfied with the result included 8 with a urethral obstruction, 6 with urge incontinence and 2 with persistent SUI. Two patients with prolonged urinary retention had undergone urethrolysis. Postoperative de novo and persistent urge incontinence occurred in 2 and 4 patients, respectively. Two patients with persistent SUI were cured using the midurethral sling. Finally, forty-one patients (87.2%) were satisfied with the results, while 6 (12.8%) were unsatisfied at the 5-year follow-up.

Conclusions:

The 5-year follow-up results of the pubovaginal fascial sling surgery showed a high success rate and relatively good results with respect to satisfaction with the procedure. If a urethral obstruction and urge incontinence are treated carefully, sling surgery can be considered as an efficient method for any type of urinary incontinence.

Keywords: Urinary incontinence, stress, Treatment

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Fig. 1.

Surgical outcomes of pubovaginal fascial sling (A: 2-year f/u, B: 5-year f/u). ∗chi-square test: Linear-by-Linear association: 0.282 (2-year, 5-year).

Fig. 2.

The rates of satisfaction and dissatisfaction, and the causes of dissatisfaction (A: 2-year f/u, B: 5-year f/u).

Table 1.

Preoperative characteristics of the forty-seven patients

Mean age (years)	55.0 (33-77)
Mean symptom duration (years)	9 (0.5-35)
Previous pelvic surgery (%)	17 (36)
Previous anti-incontinence surgery (%)	3 (6)
Combined urgency/urge incontinence (%)	19 (39.6)
Valsalva leak point pressure; VLPP (cmH2O) (%)
<60	13 (27.7)
61-90	16 (34.0)
>90	18(38.3)
Pelvic organ prolapse (%)∗	22 (46)

^∗ cystocele (Grade II or Grade III) with/without rectocele

Table 2.

Comparison of the voiding parameter according to combined prolapse surgery

	Patient	Group A	Group B	p-value
Qmax∗	Preoperative	28.80 ±8.78	28.63 ±8.53	0.932
(ml/sec)	Postoperative (2 weeks)	21.52 ±5.69	12.31 ±5.29	0.000
	Postoperative (2 years)	25.88 ±8.25	24.05 ±6.93	0.481
	Postoperative (5 years)	29.44 ±4.60	27.81 ±4.14	0.222
PVR^f	Preoperative	24.40 ±16.60	21.31 ±15.37	0.515
(ml)	Postoperative (2 weeks)	36.80±21.96	38.41 ±11.72	0.342
	Postoperative (2 years)	29.56±17.74	30.27 ±10.04	0.305
	Postoperative (5 years)	26.44 ±20.03	25.36±18.22	0.839

Group A: pubovaginal sling without pelvic organ prolapse repair, Group B: pubovaginal sling with pelvic organ prolapse repair.

^∗ Qmax: maximum voiding flow rate,

^† PVR: post voiding residual urine

Table 3.

Comparison of the preoperative and postoperative (2- & 5-year follow-ups) subjective SEAPI scores

SEAPI score	Preoperation	2-year. f/u	5-year. f/u	p-value
SEAPI score	Preoperation	2-year. f/u	5-year. f/u	preop.: 2-year. f/u	2-year. f/u: 5-year. f/u
Stress-related leakage	2.00 ±0.59	0.34 ±0.48	0.38 ±0.49	0.002	0.160
Emptying ability	0.06 ±0.25	0.65 ±0.48	0.12 ±0.54	<0.001	0.040
Anatomy	2.15 ±0.36	2.00 ±0.66	1.11 ±0.76	0.051	<0.001
Protection	1.80±1.21	0.27 ±0.74	0.21 ±0.41	<0.001	0.411
Inhibition	1.17 ±0.38	1.10±0.31	1.09 ±0.28	0.083	0.323

SEAPI: stress-related leakage, emptying ability, anatomy, protection, inhibition

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