DYNAMIC SUBURETHRAL SUSPENSION WITH PEDICLED EXTERNAL OBLIQUE APONEUROSIS IN THE MANAGEMENT OF FEMALE URINARY INCONTINENCE

Compliance with recommendations of the urodynamic society for standards of efficacy for evaluation of treatment outcomes in urinary incontinence

The Urodynamic Society (US) published (1997) minimal standards to assess the efficacy of therapy for urinary incontinence (UI). The standards were developed by a US committee and were approved by the American Urological Society. The objective of our study was to evaluate compliance with these standards in recent UI research studies. A MEDLINE search was conducted for all articles in which outcomes of treatment for UI were reported (November, 1997-October, 1999). Reported data were compared with the recommended minimum standards including pre- and posttreatment data. Compliance rates for each data field were calculated by percentages for (1) the individual article and (2) overall compliance rate among all articles. A total of 39 articles that reported treatment for UI were selected. The treatments included various surgical procedures, injectables, pharmacologic treatments, and mechanical valves. Overall compliance for each article varied between 0% and 100%. Only one article met all 100% of the recommendations and one met none. The overall mean compliance rate for each article was 29%. We conclude that there is far less than optimal reporting of outcomes for treatment of UI per the recommendations of the Urodynamic Society. This low compliance makes standardized evaluation of treatment outcomes of UI difficult if not impossible. We suggest that initiation of funded cooperative clinical trials may improve the standardization in UI.

Cadaveric fascia lata pubovaginal slings: early results on safety, efficacy and patient satisfaction

OBJECTIVE

To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI).

PATIENTS AND METHODS

Thirty-one women with SUI (25 type II and six type III; mean age 63 years, range 40-75) had a CFL pubovaginal sling placed transvaginally. The operative time, blood loss, surgical complications and mean hospital stay were all documented. Before and at 4 months and 1 year after surgery each patient completed a 3-day voiding diary and validated voiding questionnaires (functional inquiry into voiding habits, Urogenital Distress Inventory and Incontinence Impact Questionnaire, including visual analogue scales).

RESULTS

The mean (range) operative time was 71 (50-120) min, blood loss 78.7 (20-250) mL and hospital stay 1.2 (1-2) days; there were no surgical complications. Over the mean follow-up of 13.5 months, complete resolution of SUI was reported by 29 (93%) patients. Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (< 15 cmH2O) voiding pressures before surgery required self-catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty-four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use (P < 0.05). The severity of leak and storage symptoms was also significantly less (P < 0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, approximately 80% of the patients said they would undergo the procedure again and/or recommend it to a friend.

CONCLUSION

Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.

Genuine stress incontinence: colpocystourethropexy versus sling procedures

Both colpocystourethropexy (colposuspension) and sling operations have been shown to be effective in treating female stress incontinence. The present review discusses the literature available and compares the results and complications of both procedures. Colposuspension can give excellent results as both primary and secondary surgery. Slings also give excellent results, but are prone to complications relating to the sling material and postoperative voiding difficulties. Slings are arguably best reserved for women in whom vaginal scarring makes colposuspension impossible. Colposuspension remains the gold standard operation against which new techniques should be compared.

Surgical management of intrinsic sphincter deficiency in women

The past decade has witnessed significant changes not only in our understanding of intrinsic sphincter deficiency, but also in our surgical approach to this problem. It became evident that the patient's medical condition, expectations, and degree of incontinence should define the approach in order to make the greatest impact on quality of life. The present review describes the current concepts and surgical approaches to intrinsic sphincter deficiency, namely slings, injectables, and artificial sphincters.