SUBURETHRAL SLING EMPLOYING THE TRANSOBTURATOR APPROACH: A QUALITY OF LIFE ANALYSIS

J. Lukban, O. Aguirre

Urogynecology Associates of Colorado, Denver CO

OBJECTIVE: To determine the degree of benefit of a transobturator mid-urethral polypropylene sling in improving quality of life in patients with stress urinary incontinence (SUI).

MATERIALS AND METHODS: A retrospective chart review was performed of 47 patients who underwent treatment with the Monarc subfascial hammock by a single surgeon (principal author) between July 2003 and June 2004.  All subjects completed a urodynamic evaluation preoperatively. Surgery was performed under general anesthesia, using a Kelly clamp as a spacer to ensure appropriate tensioning.  All patients completed the validated Individual Incontinence Impact Questionnaire (IIIQ) both before and after treatment.  Subjects also completed the validated Patient Satisfaction Questionnaire (PSQ) postoperatively to complete lower urinary tract quality of life analysis.  Statistical analyses included a paired t-test for intra-pair comparisons, and two-group t-tests to identify group differences. 

RESULTS: Twenty-six subjects (55.3%) initially reported mixed incontinence, 20 (42.6%) reported stress incontinence alone, and 1 (2.1%) reported no leakage.  Fourteen patients (29.8%) had a history of at least one prior anti-incontinence procedure.  Forty-six patients (97.9%) exhibited urethral hypermobility (Q-tip angle > 30 degrees from horizontal with straining).  All subjects were confirmed to have urodynamic SUI, with nine (19.1%) identified as having ISD.  Thirty-two patients (68.1%) had concomitant pelvic surgery at the time of sling placement.  Average follow-up was 8.5 + 3.2 months (range 3-15).  IIIQ scores for the entire sample improved from a preoperative mean of 43.0 + 27.0% to a postoperative mean of 11.8 + 16.4% (P < .0001).  Preoperative IIIQ scores for patients who had previous anti-incontinence surgery were higher than for primary surgical candidates (56.6 + 27.0% versus 37.3 + 25.3%, P = .023) yet postoperative scores for the two groups showed no significant difference (16.1 + 22.8% versus 10.0 + 12.9%).  A comparison of patients with ISD to those without revealed no significant difference in IIIQ scores either preoperatively (49.5 + 21.4% versus 41.5 + 28.2%) or postoperatively (12.8% + 13.1% versus 11.6 + 17.3%).  Upon review of PSQ responses, thirty-three patients (70.2%) were “completely satisfied”, 12 (25.5%) were “somewhat satisfied”, and only 2 (4.3%) were “not satisfied”.  Forty-two subjects (89.4%) stated their leakage was “much better or better”, forty-two (89.4%) responded “yes” to having fewer accidents, and forty-two (89.4%) reported no postoperative restrictions in activity. 

CONCLUSIONS: The transobturator mid-urethral sling provided significant improvement in quality of life.  Additionally, the degree of benefit seen in patients with previous surgery was found to be equal to that seen in primary surgical candidates, with similar benefit seen between those with and without ISD.

Key Words: sling, stress urinary incontinence, quality of life

Disclosure - Proctor: J. Lukban, Meditronic, American Medical Systems; O. Aguirre, Gynecare, Medtronic; Speakers Bureau: J. Lukban, Medtronic, AMS, Pharmacia, Watson; O. Aguirre, Gynecare, Watson; Consultant: J. Lukban, AMS; O. Aguirre, Gynecare, Advanced Bionics, Proctor & Gamble.