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An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome.
J Urol. 1999 Jul; 162(1):135-7.JU

Abstract

PURPOSE

We assessed the urodynamic changes after pubovaginal sling procedure for stress incontinence, particularly in regard to the associated symptoms of urgency, frequency, nocturia and urge incontinence, known as the urge syndrome.

MATERIALS AND METHODS

A total of 85 women with proved stress incontinence underwent a pubovaginal sling procedure using rectus fascia between 1992 and August 1996. Of the women 41 (48%) had undergone previous anti-incontinence surgery and 59 (69%) had the associated urge syndrome. There was at least some degree of hypermobility in 51 cases and type III stress incontinence was diagnosed in 34. Patients were assessed with a questionnaire and video urodynamics preoperatively and 3 months postoperatively. Preoperative and postoperative ambulatory studies were performed in 25 cases.

RESULTS

Of the 85 patients 83 (97%) were symptomatically cured of stress incontinence. The urge syndrome resolved in 32 patients (69%), almost all of whom had a closed bladder neck at rest. Overall bladder neck incompetence at rest decreased from 57 to 18% (p<0.001). Of 27 patients with the persistent urge syndrome postoperatively 9 (41%) had an open bladder neck at rest compared to 4 of 50 (8%) without urge incontinence (p<0.01). Despite symptomatic control of stress incontinence in 83 patients (97%), only 66 were satisfied with the surgical result, mainly because of the persistent urge syndrome in 27. Despite care to avoid obstruction overall, there were statistically significant obstructive changes in detrusor pressure at maximum flow rate, maximum flow rate and residual urine volumes.

CONCLUSIONS

The pubovaginal sling is effective in curing genuine stress incontinence and, when correctly placed at the right tension, the associated urge syndrome also can be managed, usually by achieving bladder neck closure at rest. However, despite careful maneuvers, obstruction occasionally persists.

Authors+Show Affiliations

Urological Unit, University Hospital of Wales, Cardiff.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

10379756

Citation

Fulford, S C., et al. "An Assessment of the Surgical Outcome and Urodynamic Effects of the Pubovaginal Sling for Stress Incontinence and the Associated Urge Syndrome." The Journal of Urology, vol. 162, no. 1, 1999, pp. 135-7.
Fulford SC, Flynn R, Barrington J, et al. An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome. J Urol. 1999;162(1):135-7.
Fulford, S. C., Flynn, R., Barrington, J., Appanna, T., & Stephenson, T. P. (1999). An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome. The Journal of Urology, 162(1), 135-7.
Fulford SC, et al. An Assessment of the Surgical Outcome and Urodynamic Effects of the Pubovaginal Sling for Stress Incontinence and the Associated Urge Syndrome. J Urol. 1999;162(1):135-7. PubMed PMID: 10379756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome. AU - Fulford,S C, AU - Flynn,R, AU - Barrington,J, AU - Appanna,T, AU - Stephenson,T P, PY - 1999/6/24/pubmed PY - 1999/6/24/medline PY - 1999/6/24/entrez SP - 135 EP - 7 JF - The Journal of urology JO - J Urol VL - 162 IS - 1 N2 - PURPOSE: We assessed the urodynamic changes after pubovaginal sling procedure for stress incontinence, particularly in regard to the associated symptoms of urgency, frequency, nocturia and urge incontinence, known as the urge syndrome. MATERIALS AND METHODS: A total of 85 women with proved stress incontinence underwent a pubovaginal sling procedure using rectus fascia between 1992 and August 1996. Of the women 41 (48%) had undergone previous anti-incontinence surgery and 59 (69%) had the associated urge syndrome. There was at least some degree of hypermobility in 51 cases and type III stress incontinence was diagnosed in 34. Patients were assessed with a questionnaire and video urodynamics preoperatively and 3 months postoperatively. Preoperative and postoperative ambulatory studies were performed in 25 cases. RESULTS: Of the 85 patients 83 (97%) were symptomatically cured of stress incontinence. The urge syndrome resolved in 32 patients (69%), almost all of whom had a closed bladder neck at rest. Overall bladder neck incompetence at rest decreased from 57 to 18% (p<0.001). Of 27 patients with the persistent urge syndrome postoperatively 9 (41%) had an open bladder neck at rest compared to 4 of 50 (8%) without urge incontinence (p<0.01). Despite symptomatic control of stress incontinence in 83 patients (97%), only 66 were satisfied with the surgical result, mainly because of the persistent urge syndrome in 27. Despite care to avoid obstruction overall, there were statistically significant obstructive changes in detrusor pressure at maximum flow rate, maximum flow rate and residual urine volumes. CONCLUSIONS: The pubovaginal sling is effective in curing genuine stress incontinence and, when correctly placed at the right tension, the associated urge syndrome also can be managed, usually by achieving bladder neck closure at rest. However, despite careful maneuvers, obstruction occasionally persists. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/10379756/An_assessment_of_the_surgical_outcome_and_urodynamic_effects_of_the_pubovaginal_sling_for_stress_incontinence_and_the_associated_urge_syndrome_ L2 - https://www.jurology.com/doi/10.1097/00005392-199907000-00033?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -