eMedicine Specialties > Urology > Incontinence

Pubovaginal Sling: Follow-up

Author: Sandip P Vasavada, MD, Physician, Center for Female Pelvic Medicine and Genitourinary Reconstructive Surgery, The Glickman Urological and Kidney Institute; Joint Appointment with Women's Institute, Cleveland Clinic
Coauthor(s): Raymond Rackley, MD, Professor of Surgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Staff Physician, Center for Pelvic Medicine and Pelvic Reconstruction, Glickman Urological Institute, Cleveland Clinic Foundation
Contributor Information and Disclosures

Updated: May 4, 2009

Outcome and Prognosis

Rectus fascia pubovaginal sling: Available medical literature reports a postoperative continence rate of 81%-95% after 4 years. For more than 10 years, many surgeons have successfully used this operation for treatment of intrinsic sphincter deficiency (ISD).

Fascia lata pubovaginal sling: Long-term data for more than 4 years shows a 78%-92% postoperative continence rate with this operation. Continence surgeons used this procedure for more than 22 years, with excellent results for complicated and simple stress urinary incontinence (SUI).

Rectus fascia suburethral sling: The long-term postoperative continence rate of this procedure is 80%-82% after 4 years. Some surgeons prefer this patch-sling operation to the long pubovaginal sling because of the reduced morbidity and the faster recuperative period.

Fascia lata suburethral sling: Available medical literature reports an 80%-92% lasting cure rate for more than 4 years. Some surgeons prefer this short suburethral sling to the long pubovaginal sling because of the reduced morbidity and the faster recuperative period.

Vaginal wall suburethral sling: This operation produces postoperative continence rates of 70%-94% at a mean follow-up of 2 years. Long-term data for more than 4 years are not yet available. This sling operation does not require secondary harvesting of the abdomen or thigh; however, this surgery is no longer favored for the treatment of type-III SUI.

Gore-Tex patch sling: Available medical literature reports a postoperative continence rate of 88% at a mean follow-up of 4.2 years. Surgeons have used this operation for more than 7 years. Women undergoing this operation have reported a high level of satisfaction with their experience.

Tension-free vaginal tape: The long-term cure rate is 84% at a mean follow-up of over 10 years. Five years of follow-up data show that transobturator tape (TOT) procedures have good durability, and short-term studies have confirmed noninferiority to tension-free vaginal tape (TVT) procedures. However, Schierlitz et al (2008) found that retropubic TVT was more effective than TOT sling in women with urodynamic SUI and ISD.4

Note that, whatever sling surgery is performed, one should use the technique that produces the best outcomes in the hands of that particular surgeon.

Future and Controversies

Surgeons currently use a number of materials for constructing pubovaginal slings, with excellent outcomes. All types of stress urinary incontinence (SUI) may be corrected with pubovaginal sling surgery. Serious complications from sling surgery are uncommon. The choice of sling material and sling surgery is predominantly one of surgeon preference, the condition of host fascia/tissue, and previous surgery. The ideal sling material to use and the method of fixation are controversial.

Recurrent SUI after vaginal and/or urethral erosion: Use classic pubovaginal or hemislings constructed with rectus fascia; otherwise, the synthetic midurethral tension-free slings placed retrograde (tension-free vaginal tape [TVT]) or antegrade should suffice for most patients.

As better insight into the relationship between the sling materials and the host response is elucidated, the success rates of sling surgery will continue to improve. Synthetic polypropylene mesh midurethral slings seem to have some of the best durability with the least problems at present and will be hard to improve upon in the future. Perhaps tissue engineering using autologous stem cells is the next step in the evolution of pubovaginal slings for definitive correction of female SUI.

 


More on Pubovaginal Sling

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Treatment: Pubovaginal Sling
Follow-up: Pubovaginal Sling
Multimedia: Pubovaginal Sling
References
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References

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Further Reading

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Keywords

pubovaginal sling, incontinence, urinary incontinence, stress incontinence, urge incontinence, overflow incontinence, mixed incontinence, reflex incontinence, decompensated bladder, detrusor instability, Marshall test, Kegel exercises, detrusor hyperreflexia, overactive bladder, SUI, urethral hypermobility, intrinsic sphincter deficiency, ISD, sling, pubovaginal sling, bladder sling, suburethral sling, bladder neck suspension, urethropexy, transvaginal urethropexy, retropubic urethropexy, MUI, mixed urinary incontinence, stress urinary incontinence, urge urinary incontinence

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Contributor Information and Disclosures

Author

Sandip P Vasavada, MD, Physician, Center for Female Pelvic Medicine and Genitourinary Reconstructive Surgery, The Glickman Urological and Kidney Institute; Joint Appointment with Women's Institute, Cleveland Clinic
Sandip P Vasavada, MD is a member of the following medical societies: American Urogynecologic Society, American Urological Association, International Continence Society, and Society for Urology and Engineering
Disclosure: pfizer Honoraria Speaking and teaching; allergan Consulting fee Consulting; ndi medical, LLC Ownership interest Review panel membership; novartis Honoraria Speaking and teaching

Coauthor(s)

Raymond Rackley, MD, Professor of Surgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Staff Physician, Center for Pelvic Medicine and Pelvic Reconstruction, Glickman Urological Institute, Cleveland Clinic Foundation
Raymond Rackley, MD is a member of the following medical societies: American Urological Association
Disclosure: Pfizer, Novartis, Proctor & Gamble, Allergan Honoraria None; Pfizer, Novartis, Proctor & Gamble, Allergan Consulting fee Other

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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