Expanded Indications for the Pubovaginal Sling: Treatment of Type 2 or 3 Stress Incontinence

Abstract

Purpose The usefulness of the pubovaginal sling procedure as primary treatment of stress incontinence associated with urethral hypermobility (type 2) or intrinsic sphincter deficiency (type 3) was determined. Materials and Methods A total of 60 consecutive cases of type 2 or 3 stress urinary incontinence was treated with a pubovaginal sling by 1 surgeon using a previously reported technique. Fluoroscopic urodynamic studies with leak point pressures were used to classify the type of incontinence. Of the 60 women 38 (63 percent) were diagnosed with type 2 and 22 (37 percent) with type 3 stress urinary incontinence. Of these patients 24 had previously undergone 1 or more anti-incontinence procedures. Results At a mean followup of 25 months 57 of the 60 patients (95 percent) were completely continent. In addition, 69 percent of patients with urgency had resolution of the urgency symptoms following the sling procedure. Transient postoperative urinary retention (median duration 6.5 days) was present in 60 percent of the patients. However, all women subsequently voided spontaneously without requiring further intermittent or Foley catheterization. Other complications occurred infrequently, and included urinary tract infection (13 percent of cases), de novo urgency (12 percent) and persistent incisional pain (5 percent). Conclusions These early results suggest that the pubovaginal sling is a safe and effective treatment for primary or recurrent type 2 or 3 stress incontinence. The most worrisome complication, urinary retention, occurred temporarily in more than half of the patients but eventually resolved in all cases, usually within 10 days.