EH05-003: A RETROSPECTIVE EVALUATION COMPARING PORCINE DERMIS AND CADAVARIC FASCIA FOR THE TREATMENT OF GENUINE STRESS INCONTINENCE AND LOW PRESSURE URETHRA WITH A TRANSVAGINAL COOPER'S LIGAMENT SLING

J.R. Miller, S. Gandhi, S.M. Botros, Y. Abramov, R.P. Goldberg, P.K. Sand

Evanston Continence Center, Evanston, IL; Northwestern University, Feinberg School of Medicine, Chicago, IL

OBJECTIVE: Compare the subjective and objective comparison of patients that underwent a transvaginal Cooper’s ligament sling procedure using porcine dermis versus cadaveric fascia lata for urodynamic stress incontinence with a low-pressure urethra

MATERIALS AND METHODS: Retrospective cohort study including all patients (N=226) who underwent a transvaginal Cooper’s ligament sling using either porcine dermis or cadaveric fascia lata within our Division between July, 2000 and May, 2003.  Subjective outcome variables included stress and urge incontinence. Objective outcome variables included support provided by the sling (Q-tip test), presence of incontinence (multichannel urodynamics) and retention (post void residual). Statistical analysis of variance compared subjective and objective outcomes of the 2 different materials.

RESULTS: Among patients completing fourteen week postoperative urodynamics, there was a significant difference in the percent cured of detrusor overactivity (22% cadaveric fascia vs. 43% porcine dermis, p 0.004) but no difference in the percent cured of urodynamic stress incontinence (68% vs. 68%, p >0.2).  Subjective cure rates for patients completing fourteen week postoperative quality of life questionnaires were similar between the cohorts for both stress urinary incontinence (82% vs. 71%, p 0.118) and urge urinary incontinence (39% vs. 38%, p >0.2).  There were no significant differences between cohorts with respect to either Q-tip straining angle (mean 10.2 degrees vs. 11.1, P > 0.2) or post-operative retention (PVR > 50cc; 22% vs. 25%, p > 0.2); however, there was a significant difference with respect to post-operative retention as defined by need for urethrolysis (1.2% vs. 6.6%, p 0.02). 

CONCLUSION: When used during a Cooper’s ligament sling procedure, porcine dermis is equivalent to cadaveric fascia lata 14 weeks post-operatively in subjective and objective cure of stress urinary incontinence, post-operative suburethral support and urinary retention; but had better outcomes for the treatment of concurrent detrusor overactivity and more post-operative retention requiring urethrolysis.  Further follow-up with 52 weeks post-operative data will be available by the conference. 

Key Words: urinary incontinence, sling, porcine dermis, fascia lata

Disclosure – Consultant: R. Goldberg, Watson; Speakers Bureau: P.K. Sand, Alza/Ortho-McNeil, Watson, American Medical Systems; Advisory Board: P.K. Sand, Alza/Ortho-McNeil, Watson, American Medical Systems, Indevus, Yamanouchi, Roche, Pfizer, Bioform, Lilly, Boeringer-Ingelheim, Mentor, Novasys; Grant/Research: P.K. Sand, Alza/Ortho-McNeil, Watson, American Medical Systems, Indevus, Yamanouchi, Roche, Pfizer, Bioform, Lilly, Boeringer-Ingelheim, Mentor, Novasys.