BERKELEY, CA (UroToday.com) - We evaluated the efficacy of the autologus free rectus fascia pubo-vaginal sling (PVS) for the treatment of female stress urinary incontinence (SUI) through our experience at a single institution, from a single surgeon, over a period of 3 years. Patient satisfaction and morbidity were also recorded. In addition, we investigated possible correlations between preoperative parameters and outcomes.
A retrospective chart review for 264 female SUI patients who underwent an autologus rectus fascia PVS by a single surgeon between March 2002 and March 2005 was conducted. Preoperative evaluation included a urogynecological history and physical examination, urinalysis, and flexible urethrocystoscopy. Patients also underwent fluoroscopic urodynamic studies (FUDS) to rule out detrusor overactivity and to quantify the degree of intrinsic sphincter deficiency (ISD). Valsalva Leak Point Pressure (VLPP) was also estimated. Preoperative incontinence severity was quantified by the number of pads used per day and stratified as mild (0 to 1 pads per day), moderate (2-4 pads), and severe (5 or more pads). Persistent or recurrent urethral incontinence was recorded as failure and was defined as leakage requiring >1 pad per day during follow-up. The use of 1 pad per day was defined as improvement only if this represented a reduction in pad use greater or equal to 50% and, additionally, was reported as satisfactory by the patient. Cure was defined as no leakage per urethra.
The mean age of the patients was 53 yrs (17-82) and mean follow-up time was 27.8 months (range: 12-78 m). Preoperative incontinence severity was mild in 5 (1.9 %), moderate in 64 (24.2 %) and severe in 195 (73.9 %) cases. Complete resolution of stress urinary incontinence was achieved in 200 out of 264 patients (75.6%). Moreover, 24 patients (9.1%) had improved markedly but still required one pad per day. Forty patients (15.2%) finally failed to demonstrate any improvement. It should be underline that in this study the vast majority of patients (74.4%) had severe incontinence, a fact that emphasizes the efficacy of the PVS technique.
Complications were encountered in 77/264 patients (29.16%). Post operative urgency was the most common side effect encountered by 49 patients (18.5%) - of whom 19 (7.2%) presented with urgency incontinence, although SUI was cured. On the other hand, an interesting finding in this series is that in 21/36 (58.3%) of the patients with evidence of pre-operative bladder overactivity and urgency, complete resolution of urgency occurred post-operatively. In addition, transient obstruction or urinary retention presented in 28 women (10.6%).
Regarding preoperative factors affecting potentially outcome, no statistical significance was reached for any of the following parameters (p<0.05 in all cases): patient age, former anti-incontinence surgery, obesity, menopause, incontinence severity, pre-operative VLPP, presence of obstruction, prolapse grade ≥2, increased sensitivity, decreased bladder capacity, and preoperative evidence of detrusor overactivity.
Although currently, tension-free mid-urethra synthetic vaginal tapes seem to be a very effective and popular procedure for the treatment of SUI, we believe that the PVS procedure with autologous fascia still has an important role in the surgical armamentarium, especially for complicated and recurrent cases of SUI, even when overactivity is present.
A. Athanasopoulos, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.