AUA 2019: Long Term Outcomes of Autologous Pubovaginal Sling in Patients with Neurogenic Bladder

Chicago, IL (UroToday.com) This was retrospective review of patients with NGB who received an autologous PVS from January 1st, 2000 - December 31st, 2017 at a single center. Patients with NGB undergoing PVS were identified from electronic medical record using CPT codes. Subjective and objective outcomes were collected including American Urologic Association Symptom Index (AUA-SI) and Incontinence Symptom Index (ISI).

The authors aimed here to assess long-term outcomes of PVS in neurogenic urinary incontinence. They found that despite its utility in the non-neurogenic population, limited objective data exists regarding the efficacy of autologous pubovaginal sling (PVS) placement for management of urinary incontinence in patients with neurogenic bladder (NGB).

During their review there was a 31 women with NGB receiving PVS were included. Patients had a mean age of 55+/-16 years and BMI of 28.7+/-7 kg/m2. Six patients (19.3%) had previously failed PVS. Preoperatively, patients were managed with clean intermittent catheterization (CIC) (64.5%), urethral catheter (16.1%), ileovesicostomy (6.4%), and suprapubic tube (SPT) (3.2%). Cross-over PVS placement technique was used in 16.1% and 67.7% had concomitant procedures including 8 augmentations, 3 ileovesicostomies, and 4 SPTs. At a mean follow-up of 36+/-24 months, 23 patients (74.2%) reported continued incontinence. Mean AUA-SI scores decreased from 14.8+/-9.8 to 9.7+/-10.3 (p=0.002), AUA-QoL from 5.0+/-1.87 to 2.9+/-2.1 (p=0.100), ISI-Severity from 17.3+/-10.1 to 10.7+/-9.5 (p=0.039), and ISI-Bother from 4.2+/-2.6 to 3.2+/-2.6 (p=0.016) . Four women underwent ileal conduit for persistent incontinence.

They concluded that despite the most patients continued to have incontinence after PVS, significant improvement in objective measures was noted. This data is limited by a small retrospective nature of the review and further studies are needed to understand the role of PVS as a treatment option for urinary incontinence in NGB.

Presented by: Rachel Bergman, University of Michigan Medical School

Co-authors: Iryna Crescenze, Anne Cameron, Ann Arbor, MI

Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine Twitter: @BilalfarhanMD at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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