Comparison of Anterior Vaginal Wall Sling and Pubovaginal Fascial Sling in the Management of Intrinsic Sphincteric Deficiency

Lee, Sung Won; Choi, Jin Ho; Lee, Kyu Sung

Abstract

PURPOSE: Pubovaginal sling using a strip of rectus fascia to compress the urethra has been the best known treatment for the stress urinary incontinence caused by intrinsic sphincteric deficiency. Recently, sling procedure utilizing the anterior vaginal wall have come forth and the procedure appeared to be performed easily more than the pubovaginal sling. The aim of this study was to compare the safety and efficacy of the pubovaginal versus the anterior vaginal wall slings in treating women with intrinsic sphincteric deficiency. MATERIALS AND METHODS: We retrospectively compared 12 women treated with pubovaginal slings(Group I) for intrinsic sphincteric deficiency to 15 women treated with anterior vaginal wall slings(Group II). Parameters of evaluation included the postoperative presence of stress or urge incontinence, operation time, complications, duration of suprapubic catheterization, hospital stay, days lost from work, and satisfaction score. RESULTS: Baseline clinical and urodynamic data were comparable for both groups. With a mean follow-up of 22 months(range 9-30) for group I, 12(100%) were cured. In group II, with a mean follow-up of 18 months(range 15-20), 14(93%) were cured and 1(6.7%) improved. Postoperative de novo urge incontinence was present in 1(6.7%) patient in group II. Group I(100%) and group II(93%) were either very satisfied or somewhat satisfied with their surgical outcome. The operative time and hospital stays of group II were significantly lower than those of group I. There were no statistically significant differences between the 2 groups in catheterization duration and days lost from work. CONCLUSIONS: We concluded that both techniques are equally effective in treating women with stress incontinence caused by intrinsic sphincteric deficiency. However, the use of anterior vaginal wall slings resulted in significantly shorter operative time and hospital stay compared with pubovaginal slings. Therefore, the anterior vaginal wall slings may be the preferable surgical method in treating intrinsic sphincteric deficiency.