Pubovaginal Sling Research Articles

Transobturator vaginal wall sling (Elgamasy technique) for the treatment of female stress urinary incontinence: a pilot study

BackgroundStress urinary incontinence (SUI) is a common social problem that affect about 4–35% of adult women adult. There are multiple surgical options for treatment of SUI but midurethral slings are the most effective and durable form of treatment. In this study, transobturator vaginal sling (TOT-VS, Elgamasy technique) was used to overcome the unique risks associated with synthetic mesh placement, as well as the higher rate of voiding dysfunction and harvest site complications associated with pubovaginal sling placement.Objective To assess the short-term outcome of transobturator vaginal wall sling (TOT-VS) for the treatment of SUI.Materials and MethodsThis is a prospective study included 20 females who underwent TOT-VS placement for SUI from January 2021 to March 2022 at Tanta Urology Department–Tanta University Hospitals. Two-parallel longitudinal vaginal mucosal incisions were performed 2 cm below the bladder neck, and 6 × 2 cm graft was harvested from the anterior vaginal wall, with a prolene suture on each side and fixed around the urethra via the transobturator rout. Patients were followed in the outpatient clinic after one week, two weeks, 3, 6 months and one year postoperatively. Outcomes were measured subjectively by the Bristol Female Lower Urinary Tract Symptoms (B-FLUTS) score comparing preoperative and postoperative scores and objectively by cough stress test.ResultsThe median age of patients was 42 years, and the median BMI was 30.0 kg/m2. The technique was performed, and the patient was discharged the next day after surgery. Mean operative time was 50.5 ± 9 min. All patients completed B-FLUTS at the last follow-up. Compared to preoperative scores, all patients showed significant improvement in all domains. Nineteen cases (95%) showed negative cough stress test 6 months postoperatively, and none of them suffered from severe (Clavien III-V) complications or required reoperation to release the sling. The procedure was failed in one case (5%). At one-year follow-up, no recurrence of SUI was recorded in any case.ConclusionIn the treatment of female stress urinary incontinence, transobturator vaginal wall slings can be a viable, autologous and cost-effective option with excellent short-term outcome, no recurrence, short operative periods, minor complications and short hospital stays.

Effect of lower urinary tract conditions on surgical outcomes of different suburethral sling procedures for female stress urinary incontinence.

The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures. From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures. Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria. TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE.

Cosmetic and functional impact of fascia lata harvest for use in surgery for stress urinary incontinence.

There has been increased interest in using autologous tissues since the Food and Drug Administration banned transvaginal mesh for pelvic organ prolapse in 2019. Our study aims to assess patients' perspective of functional and cosmetic impact on the fascia lata harvest site in patients undergoing fascia lata harvest for the treatment of stress urinary incontinence (SUI). This is a prospective survey study of a retrospective cohort of patients who underwent a fascia lata pubovaginal sling between 2017 and 2022. Participants completed a survey regarding the functional and cosmetic outcomes of the harvest site. Seventy-two patients met the inclusion criteria. Twenty-nine patients completed the survey for a completion rate of 40.3%. For functional symptoms, 24.1% (7/29) of patients reported leg discomfort, 10.3% (3/29) reported leg weakness, 10.3% (3/29) reported a bulge, 17.2% (5/29) reported scar pain, 14.8% (4/27) reported scar numbness, and 17.2% (5/29) reported paresthesia at the scar. For cosmetic outcomes, 72.4% (21/29) reported an excellent or good scar appearance. On the PGI-I, 75.9% (22/29) reported their condition as very much better (48.3%, 14/29) or much better (27.6%, 8/29). The majority of patients reported being satisfied with the functional and cosmetic outcomes of their harvest site as well as satisfied with the improvement in their SUI. Less than 25% of patients report harvest site symptoms, including leg weakness, scar bulging, scar pain, scar numbness, or paresthesia in the scar. This is important in the context of appropriate preoperative discussion and counseling regarding fascia lata harvest.

Analysis of British Columbia practice patterns in the management of female stress urinary incontinence with emphasis on mesh use.

Female stress urinary incontinence (SUI) is common and has a profound impact on quality of life. Suburethral slings are the most common treatment for SUI in this population. These can be placed with synthetic mesh or autologous fascia. Mesh-related complications after midurethral sling procedures are documented in the literature but the risk of complications and reoperation is lower than the use of transvaginal mesh for pelvic organ prolapse repair. In this study, we sought to evaluate local practice patterns of management of female SUI with specific emphasis on mesh use. A survey created by an expert panel was disseminated to respective provincial societies. Sixty-eight percent of respondents offer midurethral slings in their practice but only 60.6% of these respondents would offer surgical removal of the sling if there were complications, such as mesh erosion or pain. A large portion (39.4%) of respondents are performing transobturator slings as compared to retropubic midurethral slings (36.3%) and only 8.5% have removed the leg component associated with the transobturator sling in their practice. Furthermore, compared to most respondents offering midurethral slings (64.8%), only a minority of surgeons offer alternatives: 23.9% of respondents offer periurethral bulking agent injections, 15.5% offer pubovaginal slings, and 12.7% offer retropubic urethropexies. Our study supports that surgeons should continue to review surgical risks and alternative treatment options as part of the surgical consent process. As such, surgeons should be able to offer a variety of surgical approaches to manage female SUI.

Evaluation of autologous pubovaginal sling for treatment of female stress urinary incontinence

Evaluation of autologous pubovaginal sling for treatment of female stress urinary incontinence

Ultra Long-term Follow-up of the Autologous Pubovaginal Sling for Stress Incontinence: Results at 23 Years

To examine the efficacy, safety, and long-term durability of the autologous pubovaginal sling for stress incontinence over a 29-year period. A total of 192 consecutive female patients with stress urinary incontinence who underwent autologous pubovaginal sling from 1993 through 1999 were analyzed over a 29-year period. Intermediate and ultra long-term follow-up were obtained at a mean of 4 and 23years, respectively. A total of 51 patients had sufficient data at both time intervals and were evaluated using a standardized questionnaire for resolution of stress incontinence, the primary endpoint, as well as resolution of urge incontinence, overall dryness, and voiding dysfunction. At intermediate-term follow-up (mean 45.3months), 96% of 51 patients reported no stress incontinence. In addition, 76% of patients experienced resolution of their preoperative urge incontinence. Overall dryness occurred in 84%. At ultra long-term follow-up (mean 22.9years), 84% reported no stress incontinence and an overall dryness rate of 53%. Postoperative voiding dysfunction included de novo urge incontinence (3 patients) and persistent urinary obstruction requiring urethrolysis (1 patient). The autologous pubovaginal sling is effective, safe, and durable at a mean of 23years, the longest known follow-up in the literature. Given the U.S. Food and Drug Administration (FDA) warnings regarding transvaginal mesh and growing concerns with the synthetic midurethral sling, the autologous pubovaginal sling should be offered as an option to those women seeking treatment for stress urinary incontinence.

The use of midurethral sling in the correction of low-stage cystoceles: a prospective randomized trial

Introduction and hypothesisThe objective was to assess whether midurethral slings (MUS) can improve both stress urinary incontinence (SUI) and cystoceles. MUS with anterior colporrhaphy (AC) as a treatment for SUI with cystocele is more invasive and carries greater risk than MUS alone.MethodsThis is a prospective randomized study involving women with stage 1 or 2 cystocele and SUI, who were > 21 years of age, who had had no previous surgery for SUI. Predominant SUI, symptomatic anterior pelvic organ prolapse, and informed consent were mandatory. Patients were randomized as to whether AC had been performed. The sling procedure was left to the surgeon’s discretion: pubovaginal sling, tension-free vaginal tape, or trans-obturator tape. Success was defined as a negative stress test and no evidence of cystocele upon local examination.ResultsNinety-eight patients were enrolled, 48 underwent MUS, and 50 underwent MUS and AC. Mean age ± SD was 44.96 ± 8.13 years. Baseline characteristics were similar. Operative time and blood loss were significantly higher in the MUS/AC group (p = 0.01 and 0.02 respectively). At 3 months, success was 79.1% and 77.8% in the MUS and MUS/AC groups respectively. This was maintained until 6 months (79.1% and 77.8% respectively). At 1 year, the results were comparable with success rates of 96.2% and 87.0% in the MUS and MUS and AC groups respectively. Symptom scores were comparable at 6- and 12-month evaluations.ConclusionMidurethral slings correct symptomatic stage 1 or 2 cystoceles without the need for AC, which carries the risk of a significantly longer procedure and more significant blood loss.

Comparison of midurethral tape with autologous rectus fascial sling surgery for stress urinary incontinence: A systematic review and meta-analysis

Abstract Objectives To compare the success rates of autologous fascial mesh (sling and transobturator tape [TOT]) with midurethral synthetic meshes (tension-free vaginal tape sling [TVT] and TOT) for stress urinary incontinence. Materials and methods A literature search for studies published in English was conducted from May 10, 2022, to June 1, 2022. The search included MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar, and ProQuest, using the terms{“Autologous fascial slings”}OR {“AFS”} AND{“TOT”} OR {“Transobturator tape”} OR{“TVT”} OR{“Transvaginal tape”}. A total of 20 studies, including 10 randomized controlled trials, were selected for the review. RevMan software (version 5.3) was used to calculate the pooled effect estimates for operative and postoperative variables. Results In the systemic review, 20 studies, including 10 randomized controlled trials, were assessed. In the TVT versus autologous pubovaginal sling (A-PVS) groups, the effect estimates for the surgical duration, catheter duration, success, and complication rates were more advantageous for TVT. However, in comparison to autologous transobturator tape groups, TOT provided better operative time and a shorter hospital stay. Moreover, in comparison to the A-PVS group, the TOT group was superior in terms of operating time, urethral catheterization, hospital stay, amount of residual urine, and wound complications. The A-PVS group had significantly more groin and thigh pain. Conclusions During medium- and long-term follow-ups, the use of autologous rectus fascia grafts using a A-PVS or TOT provided similar complication rates and urinary continence results as using midurethral synthetic meshes (TVT and TOT).

Long-term outcomes of surgical interventions for stress urinary incontinence: a systematic review and network meta-analysis.

Stress urinary incontinence is common among women, and surgical interventions have significantly improved patients' symptoms. The long-term effectiveness of these surgeries is increasingly drawing attention, yet it remains sparsely documented in the literature. To compare the long-term effectiveness and safety of retropubic tension-free vaginal tape (TVT-RP), tension-free vaginal tape-obturator (TVT-O), transobturator tape (TOT), single-incision sling (SIS), Burch colposuspension, and pubovaginal sling (PVS). A comprehensive and systematic literature review was conducted in PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov from inception to May 2023. Selected trials were evaluated for potential bias using the Cochrane tool. Treatment modalities were compared using network meta-analysis to assess objective success rate, subjective success rate, and complications as outcomes. A total of 37 studies involving 5720 patients were included. No significant statistical differences were found among the interventions regarding objective success rate. PVS had the highest surface under the cumulative ranking curve SUCRA value (93.1). For subjective success rate, TVT-RP, TVT-O, and PVS demonstrated superiority over SIS, with PVS having the highest SUCRA value (80.1). SIS had lower overall complication and pain rates compared to other methods, with statistical significance. There were no differences in reoperation rate, exposure rate, and urinary tract infection occurrence among the surgical approaches. In terms of long-term effectiveness and safety, TVT-RP and TVT-O appear to be the preferred options for patients opting for synthetic slings, while for patients seeking nonsynthetic slings, PVS may represent the optimal choice.

Surgical Treatments for Women with Stress Urinary Incontinence: A Systematic Review.

Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding this pathology. Using network meta-analysis, we have identified the most frequently used procedures (Burch surgery, midurethral sling and pubovaginal sling), and we have described and characterized them in terms of effectiveness and safety. Midurethral procedures remain the gold standard for surgical treatment of stress urinary incontinence, although the potential of serious complications following this procedure should be taken into consideration always. There is a clear need for a much more unified evaluation of possible complications and postoperative evolution. This process will help practitioners to adapt and individualize their strategy for each patient.

Google searches for stress urinary incontinence treatment options: a worldwide trend analysis in the synthetic mesh controversy era.

To analyze trends in worldwide public interest in the treatment options for stress urinary incontinence around the latest FDA 2019 ban on vaginal mesh for prolapse. We used the web-based tool Google Trends to analyse online searches related to the following terms: 'pelvic floor muscle exercises', 'continence pessary', 'pubovaginal slings', 'Burch colposuspension', 'midurethral slings', 'injectable bulking agents'. Data were expressed as relative search volume on a scale of 0-100. Comparisons of annual relative search volume and average annual percentage change, were analyzed to assess loss or gain of interest. Finally, we assessed the impact of the last FDA alert. The mean annual relative search volume for midurethral slings was 20% in 2006 and significantly decreased until 8% in 2022 (p < 0.01). A regular decrease interest was recorded for autologous surgeries but a regain of interest for pubovaginal slings was registered since 2020 (+ 2.8%; p < 0.01). Conversely, a steep interest was noted for injectable bulking agents (average annual percentage change: + 4.4%; p < 0.01) and conservative therapies (p < 0.01). When trends were compared before and after the FDA 2019 alert, a lower research volume was found for midurethral slings, while a higher research volume was observed all others treatments (all p < 0.05). The online public researches about midurethral slings have considerably decreased following warnings on the use of transvaginal mesh. There seems to be a growing interest in conservative measures, bulking agents, and recently pubovaginal slings.

Outcomes and postoperative management of autologous fascial pubovaginal slings in females who have failed a midurethral sling

Outcomes and postoperative management of autologous fascial pubovaginal slings in females who have failed a midurethral sling

Urethroplasty and concurrent pubovaginal sling after iatrogenic urethral injury from prolonged catheterization

Urethroplasty and concurrent pubovaginal sling after iatrogenic urethral injury from prolonged catheterization

Complex Urethral Diverticulectomy: Is a Synchronous Prophylactic Autologous Fascial Sling Needed?

Urethral diverticulectomy is performed with or without concomitant pubovaginal sling (PVS). Patients with complex UD are more frequently offered concomitant PVS. However, there is paucity of literature comparing postoperative incontinence rates for patients with simple versus complex UD. The objective of this study is to examine postoperative stress urinary incontinence (SUI) rates after Urethral Diverticulectomy without concomitant PVS for both complex and simple cases. A retrospective cohort study was conducted among 55 patients who underwent Urethral Diverticulectomy from 2007 to 2021. Preoperative SUI was patient-reported and confirmed with cough stress test result. Complex cases were defined as circumferential or horseshoe configurations, prior diverticulectomy, and/or anti-incontinence procedure. Primary outcome was postoperative SUI. Secondary outcome was interval PVS. Complex and simple cases were compared using the Fisher exact test. Median age was 49 years (interquartile range, 36-58 years). Median follow-up was 5.4 months (IQR, 2-24 months). Thirty of 55 (55%) cases were simple, and 25 of 55 (45%) complex. Preoperative SUI was present in 19/57 (35%) (11 complex vs 8 simple, P = 0.25). Stress urinary incontinence persisted postoperatively in 10 of 19 (52%) (6 complex vs 4 simple, P = 0.48). De novo SUI occurred in 7 of 55, 12% (4 complex vs 3 simple, P = 0.68). Overall, 17 of 55 (31%) patients had postoperative SUI (10 complex vs 7 simple, P = 0.24). Of those, 8 of 17 underwent subsequent PVS placement (P = 0.71) and 9 of 17 had resolution of pad use after physical therapy (P = 0.27). We did not find evidence of an association between complexity and postoperative SUI. Age at surgery and preoperative frequency were the strongest predictors of postoperative SUI in this cohort. Our findings suggest successful complex urethral diverticulum repair does not require concomitant PVS.

This Month in Adult Urology.

This Month in Adult Urology.

Accreditation of an old surgical technique for stress urinary incontinence: long-term outcomes of modified autologous fascial pubovaginal sling.

To evaluate long-term outcomes of modified autologous fascial pubovaginal sling (AFPVS) in women with stress urinary incontinence (SUI). To evaluate long-term outcomes of modified AFPVS, we retrospectively reviewed the medical records of our patients from 2004 to 2015. From 2 decades ago, we have made modifications to classic surgical technique to make it simpler and faster. 199 patients were contacted with mean age of 52years. The mean follow-up period was 107months. According to Revised Urinary Incontinence Scale (RUIS) questionnaire, overall success rate was 83.9%. In patients with positive history for SUI surgery, success rate was 73% compared to 87% in those without it. Body mass index was negatively associated with cure rate. We did not encounter any major complications and most of the issues were managed conservatively. Recurrence of SUI occurred in 6 patients (3.5%) after initial improvement. Modified AFPVS is an effective surgical technique for treatment of SUI with high and durable success rate. At the present time with concerns regarding the use of transvaginal synthetic mesh, there is increasing interest and request for modified traditional procedures. It is likely that AFPVS may become more popular in upcoming years.

Surgical complications in adult urology: Pelvic and perineal surgery

Pelvic and perineal surgeries and in particular those for stress urinary incontinence and prolapse are functional surgeries, which require careful selection of patients and assessment of discomfort to expect satisfactory surgical results and reduce failure rates and of complications. Before offering pelvic and perineal surgery, the risk of potential complications should be carefully assessed and discussed with patients. Recent attention to the potential complications prosthetic mesh has raised awareness in the urological community to report complications. This chapter will focus on the complications of surgeries used for stress urinary incontinence (synthetic retropubic or transobturator suburethral slings, colposuspension, pubovaginal slings, artificial urinary sphincter, adjustable periurethral balloons and periurethral injections of bulking agents) and sacrocolpopexies. The epidemiology of complications, the minimum assessment to be carried out, treatment and prevention will be discussed.

A time-frame comparison study of surgical volume shifts on female primary stress urinary incontinence surgery.

The objective was to investigate the surgical volume shifts for primary female stress urinary incontinence (SUI) over a 20-year period (1999-2018) in Taiwan. This was a retrospective cohort study based on Taiwan's National Health Insurance Research Database. We divided the time-frame into four periods: first period (1999-2003), second period (2004-2008), third period (2009-2013), and fourth period (2014-2018). The variables included major surgical types for SUI (retropubic urethropexy, pubovaginal sling, midurethral sling, etc.), surgeon gender, specialty, surgical volume (high ≥30, median 5-29, low <5), and hospital accreditation level. Reoperation rates within 1 year were analyzed as an outcome measurement. A total of 51,018 patients were identified. Major surgical types increased significantly during the first three periods and slightly decreased during the fourth period. The proportion of surgical volume shifted from high- to medium-, and low-volume, but it reversed during the fourth period. The proportion of SUI surgeries decreased in medical centers, whereas it increased in regional and local hospitals. The proportion of SUI surgeries by female surgeons increased. Similar phenomena occurred in MUS. As for surgeon specialty, major surgical types were performed by gynecologists and urologists equally, whereas MUS were performed more by gynecologists than by urologists. Unexpectedly, 1-year reoperation rates were higher in high-volume surgeons. The surgical trend of SUI surgeries shifted from high- to medium-, and low-volume surgeons, medical centers to regional and local hospitals during the study periods. This implied surgical skills and performance spreading, which may have a great influence on patient and healthcare provider choice of treatment.

Autologous fascia pubovaginal slings in women with stress urinary incontinence at high risk of mesh/device-related complications

Very popular in many parts of the world, autologous fascial pubovaginal sling (AFPVS) remains marginally used in France. However, it may be of particular interest in patients carrying a high risk of mesh-related or device-related related complications. The aim of the present series was to report the outcomes of AFPVS in this high-risk population. The charts of all female patients who underwent a fascial sling for SUI at a single academic center between April 2019 and May 2021 were reviewed retrospectively. Only patients deemed at high-risk of device/mesh related complications were included in the present analysis: female with a neurological condition who were doing clean intermittent catheterization (CIC), female with SUI after radical cystectomy and ileal neobladder, female with urethral/bladder extrusion of any synthetic material placed for SUI. Success was defined as complete resolution of SUI at 3 months. Sixteen patients were included in this study: 13 rectus fascia slings and 3 fascia lata slings. The success rate was 56.3% (9/16 patients). Four patients were improved but not completely dry (25%). Two patients had major postoperative complications (i.e. Clavien grade 3 or higher, 11.2%). Two patients had a persisting significant post-void residual (PVR) postoperatively, managed by self-catheterization (transition to self-catheterization at 3 months: 2/8, 25%). The use of autologous fascia pubovaginal sling is an interesting option in female SUI patients with high risk of device/mesh related complications with satisfactory functional outcomes. 4.

PD24-07 FAILURE RATES OF BLADDER OUTLET SURGERIES FOR STRESS URINARY INCONTINENCE IN WOMEN WITH NEUROGENIC LOWER URINARY TRACT DYSFUNCTION: A MULTICENTER NEUROGENIC BLADDER RESEARCH GROUP STUDY DYSFUNCTION (NLUTD)

You have accessJournal of UrologyCME1 May 2022PD24-07 FAILURE RATES OF BLADDER OUTLET SURGERIES FOR STRESS URINARY INCONTINENCE IN WOMEN WITH NEUROGENIC LOWER URINARY TRACT DYSFUNCTION: A MULTICENTER NEUROGENIC BLADDER RESEARCH GROUP STUDY DYSFUNCTION (NLUTD) Javier Santiago, Min Soo Choo, Anne Cameron, Richard Mora, Evgeniy Kreydin, David A Ginsberg, Natalia Hernandez, Paola Bustillos, Rose Khavari, Stephanie Daignault-Newton, and John Stoffel Javier SantiagoJavier Santiago More articles by this author , Min Soo ChooMin Soo Choo More articles by this author , Anne CameronAnne Cameron More articles by this author , Richard MoraRichard Mora More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , David A GinsbergDavid A Ginsberg More articles by this author , Natalia HernandezNatalia Hernandez More articles by this author , Paola BustillosPaola Bustillos More articles by this author , Rose KhavariRose Khavari More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , and John StoffelJohn Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002566.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated the outcomes of bladder outlet procedures for treating stress urinary incontinence (SUI) in female patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: A retrospective multi-institutional study by the Neurogenic Bladder Research Group of female patients with NLUTD and SUI who underwent urethral bulking injection (UBI), pubovaginal sling (PVS), or artificial urinary sphincter (AUS) for (SUI) from 2012-2020 was performed via CPT and ICD-9 codes. Women undergoing concomitant bladder reconstruction or botulinum toxin (BTX) were included. The primary outcome was failure of bladder outlet procedure defined as return to pre-operative baseline SUI symptoms and/or needing additional surgical intervention for SUI. Time to failure were evaluated and multi-variable analysis for variables associated with failure were assessed. RESULTS: Thirty-five female patients were included with diagnosis of spinal cord injury (35%), spina bifida (28%), and bladder exstrophy, multiple sclerosis or auto-immune neuropathy, pelvic surgery, or a supra-pontine disorder. There were 20, 14, and 1 cases of UBI, PVS, and AUS, respectively with a median follow up of 363 days. The median age was 46 years. BTX was performed exclusively with UBI (50%) and bladder reconstruction was performed more with sling vs UBI (29% vs 0%, p=0.02). Focusing on UBI and PVS, failure rates and time to failure between procedures were not significantly different on Kaplan Meier curves at median follow up of 5 and 14 months, respectively (75% failure at median 4.8 months for UBI vs 71% at 7.3 months for PVS, p=1). 6-month failure rates were 59% and 50% for UBI and PVS. Failure was only associated with increasing age on multivariable analysis. Additional surgeries for continence were performed in 60% and 57% patients after UBI and sling, respectively. CONCLUSIONS: Urethral bulking agents and sling placement both demonstrated similarly low durability in managing SUI in NLUTD in this cohort, with the majority of patients requiring secondary surgeries for continence. This warrants further study to better understand factors impacting failure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e417 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Santiago More articles by this author Min Soo Choo More articles by this author Anne Cameron More articles by this author Richard Mora More articles by this author Evgeniy Kreydin More articles by this author David A Ginsberg More articles by this author Natalia Hernandez More articles by this author Paola Bustillos More articles by this author Rose Khavari More articles by this author Stephanie Daignault-Newton More articles by this author John Stoffel More articles by this author Expand All Advertisement PDF DownloadLoading ...