LONG-TERM OUTCOMES ANALYSIS OF ABDOMINOVAGINAL VERSUS BONE-ANCHORED SLINGS FOR THE TREATMENT OF GENUINE STRESS INCONTINENCES.

Gandhi, S. Koduri, R. P. Goldberg, C. Kwon, and P. K. Sand Evanston Continence Center, Northwestern University Medical School, Evanston, IL

   Objectives: To compare the long-term subjective and objective outcomes of abdominovaginal slings with pubic bone anchored slings. 

   Materials and Methods: This was cohort analysis of 211 women who underwent sling operations between October 1991 and March 1999.  138 underwent a abdominovaginal sling procedure (AV) and 73 underwent a bone-anchored sling procedure (BA).  Patients were called back for follow-up, which included standardized survey instruments to assess their subjective stress and urge incontinence symptoms.  In addition to pre and postoperative (at 14 weeks) urodynamic testing objective outcomes were analyzed from a standing stress test at 250 ml and a standardized 20-minute pad test at least at 52 weeks.  Low-pressure urethra was defined as mean urethral closure pressure £ 20 cm of H2O.  Statistical analysis was performed using appropriate tests for continuous and categorical variables.  Intention-to-treat analysis was conducted for short-term outcome measures and Kaplan-Meier survival analysis was attempted to determine long-term cure rates for stress incontinence.

   Results: The two cohorts had a mean age of 69 and a median parity of 3.  Mean follow-up was 153 ± 7.6 weeks.  130/138 women (94%) and 71/73 women (97%) were postmenopausal and 107/138 (76%) and 54/73 (74%) were on HRT in the AV and BA groups, respectively.  Twenty-five percent of each group had undergone a prior reconstructive surgery and approximately 17% had undergone a previous incontinence procedure.  102/138 (74%) and 54/73 (74%) patients had symptoms of urge incontinence preoperatively in the AV and BA groups, respectively.  75% of women in both groups had symptoms of stress incontinence, and the mean closure pressure was 13 and 14.5 in the AV and BA groups with almost 90% in each group having low-pressure urethra.  While only 50% and 58% of women followed-up at 1 year, seventy and sixty-six percent followed-up long-term in the AV and BA groups, respectively.  72/97 (74%) and 35/48 (73%) were without subjective stress incontinence and 37/97 (38%) and 23/48 (48%) were wit! hout subjective urge incontinence at their long-term follow-up visit in the AV and BA groups, respectively.  Median return to normal voiding was 17 and 19 days in the AV and BA groups.  There were no differences in demographic characteristics, and 14 week objective and subjective outcomes between those women who followed-up at 1 year and those that did not. 

    Conclusions:  Both pubovaginal slings and bone-anchored slings are reasonable options for the treatment of genuine stress incontinence.

    Key Words: Stress Incontinence, Surgical Therapy, Pubovaginal Sling, Bone Anchors