SUFU 2020: Very Long-Term Outcomes of Autologous Pubovaginal Fascia Slings For Urinary Incontinence In Women

Scottsdale, Arizona ( Dr. Philippe Zimmern and his team have reported on a prior series of primary (PVS1) and secondary (PVS2) slings, which had intermediate 5-10-year follow-up1, to now over >10 year follow-up.

This was a retrospective cohort study of well-characterized, on-neurogenic, women who underwent an autologous PVS for stress urinary incontinence (SUI) from intrinsic sphincter deficiency (ISD) was re-evaluated for their very long-term status. Data collected from electronic medical records included demographics and validated questionnaires (UDI-6,IIQ-7) which were compared to similar pre-operative and intermediate follow-up findings. The primary outcome was success defined as UDI-6 Question 3 (SUI) ≤ 1 and no SUI retreatment/operation. Secondary outcomes included total IIQ-7 and quality of life (QoL) scores. Patients not seen in clinics for at least 2 years were contacted via a standardized phone interview by an investigator not involved in the original care of these patients.

There were 110 patients (1996-2011) interviewed at baseline, 83 patients had intermediate follow up. Of those,5 were deceased and 34 patients provided very long term follow up based on clinic visit (7) or phone interviews (28). Those lost to follow-up (43) did not differ in demographics and intermediate outcomes from the remaining women in our study but on average lived further away (>75 miles). The mean age was 74 years old, median follow-up was 14 years (4-17), and 69% met our success criteria. Only one woman required a secondary bulking agent following the procedure. Mean postoperative questionnaire scores did not differ significantly between intermediate and very long-term follow-ups, and long-term outcomes between PVS1 and PVS2 remained similar.
The authors concluded that the majority of women with long term follow up after PVS for primary or secondary SUI secondary to ISD remained satisfied with their continence status. Both groups, PVS1 and PVS2, fared equally well, confirming the durable nature of PVS as a treatment alternative for SUI.

Presented by:
Philippe E. Zimmern, MD, Professor of Urology at UT Southwestern Medical Center and the recipient of the Felecia and John Cain Chair for Women’s Health in Urology
Sandy Kim, BS, Department of Urology, U.T. Southwestern Medical Center
Co-authors: Daniel Wong, BS1, Dominic Lee, MD2
1. U.T. Southwestern Medical Center, Department of Urology
2. St. George Hospital, Department of Urology

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona

1. Lee D, Murray S, Bacsu CD, Zimmern PE,  Long-term outcomes of autologous pubovaginal fascia slings: is there a difference between primary and secondary slings? Neurourol Urodyn. 2015;34(1):18-23.