Comparison between Autologous Rectus Fascial Pubovaginal Sling and Tension-free Vaginal Tape Procedure for Female Stress Urinary Incontinence: Outcome and Quality of Life

Lee, Won Ki; Chung, Byung Soo; Kim, Ha young

Abstract

PURPOSE: To evaluate and compare the outcomes and patients' quality of life (QOL) between autologous rectus fascial pubovaginal sling and tension free vaginal tape (TVT) procedures.
MATERIALS AND METHODS
130 women treated with an autologous rectus fascial pubovaginal sling were prospectively compared to 105 women treated with the TVT procedure. The mean follow-ups were 17.2 and 16.1 months, ranging from 3 to 55 and 2 to 36 months, for autologous rectus fascial pubovaginal sling and TVT procedure, respectively. All patients were preoperatively evaluated, with a detailed history, pelvic examination, urine analysis, abdominal leak point pressure and 1-hour pad test. A modified validated outcome questionnaire by Hassouna and Ghoniem was used to evaluate the incontinence and QOL after the incontinence procedures. The questionnaire included 14 questions related to the amount and types of leakage, the presence of voiding symptoms and the degree of bother from any symptoms. Six of the questions dealt with the patients overall satisfaction with the procedure and the impact of the procedure on the patient's social and sexual life. Cure was defined as no urinary loss at any time. Failure was defined as no improvement and use of more than one pad per day.
RESULTS
With an autologous rectus fascial pubovaginal sling, 108 patients (83.1%) were cured and 5 (3.8%) failed; whereas, with the TVT procedure, 81 patients (77.1%) were cured and 6 (5.7%) failed. In type III patients, there were no failures with an autologous rectus fascial pubovaginal sling. However, 2 patients failed with the TVT procedure. The operation satisfactions were attained with an autologous rectus fascial pubovaginal sling and the TVT procedure in 115 (88.5%) and 95 (90.5%) patients, respectively. No significant differences were noted in the continence, satisfaction or QOL in both groups.
CONCLUSIONS
Both procedures had equally high rates of cure and satisfaction in the surgical treatment of female stress urinary incontinence. However, an autologous rectus fascial pubovaginal sling should first be considered with type III SUI to avoid failure. A further long-term follow- up study of these procedures is required. (Korean J Urol 2004;45:690-695)