The long-term success of abdominovaginal sling operations for genuine stress incontinence and a cystocoele - a questionnaire-based study

Abstract

Abdominovaginal sling surgery is performed in women with genuine stress incontinence. It is not usually a primary operation because of the higher morbidity compared to the colposuspension. Slings are indicated in incontinent women with previous failed surgery, urethral hypermobility, intrinsic sphincter weakness, significant anterior vaginal wall prolapse or those with restricted vaginal mobility. This study was undertaken to assess long-term patient perceived success of abdominovaginal sling surgery in women with genuine stress incontinence (GSI) in the presence of a cystocoele. The case notes were reviewed of all 37 women undergoing sling surgery for GSI in the presence of a significant cystocoele between 1988 and 1999. Patients were sent a questionnaire at a minimum follow-up of 12 months enquiring about urinary symptoms. The mean duration of follow-up was 49 months. Six weeks following surgery 33/37 (89%) were completely dry. Thirty-three women (89%) responded to the questionnaire. Of these 14/33 (42%) were totally dry, 10/33 (30%) had insignificant leakage and 9/33 required regular protection. The mean visual analogue score of improvement in incontinence was 75·3 ( - 30·1). The operation was deemed successful in 24/33 (72%) women. Voiding difficulty was reported in 12% and recurrent prolapse occurred in 15%. Of the failures 8/9 reported urge incontinence and 4/9 stress incontinence. Frequency, urgency and urge incontinence were significantly more common in the women in whom the operation failed. This study demonstrates a 72% long-term success of abdominovaginal sling operations in women with GSI and a significant cystocoele. Development of DI accounted for most of the operative failures.