Long-term efficacy of the pubovaginal Mersilene mesh sling
Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA. American journal of obstetrics and gynecology
(Impact Factor: 4.7).
09/2009; 201(5):516.e1-7. DOI: 10.1016/j.ajog.2009.07.003
The objective of the study was to determine the efficacy of the pubovaginal Mersilene mesh sling (PVMMS) for complicated urodynamic stress incontinence (USI).
Between 1990 and 2008, patients with USI plus an at-risk diagnosis underwent a PVMMS by a single surgeon. They were followed up with urodynamics (UDE) and Pelvic Floor Distress Inventory-short form 20 (PFDI-20). Stratification was in an at-risk hierarchy: intrinsic sphincter deficiency (ISD) greater than recurrent USI (RUSI) greater than USI with chronically increased intraabdominal pressure (CI-IAP). A cough stress test determined objective cure. PFDI question 17 assessed subjective cure.
Three hundred six patients with ISD (43.5%), RUSI (26.8%), and CI-IAP (29.7%) had objective cure rates of 89.2% in the short term, 86.7% in the intermediate term, and 91.2% in the long term. A group of 48 patients with both short- and long-term UDEs showed cures of 100% and 91.7%. Long-term objective cure rates were: ISD, 90.5% (n = 21); RUSI, 84.2%, (n = 19); CI-IAP, 100% (n = 17). The mean score of postoperative PFDI question 17 was 0.57 (n = 119). Mean symptom improvement was -2.98 (n = 52; P < .0001).
We demonstrated PVMMS to be subjectively and objectively effective in long-term treatment of complicated forms of USI.
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ABSTRACT: Aim: To investigate the relationship between postoperative MRI findings and the severity score of incontinence in patients treated with pubovaginal sling surgery. & Materials and methods: Fifty-two female patients treated with pubovaginal slings were included in the study. These patients' severity scores of incontinence were evaluated in the postoperative 6th month. All the patients were examined using MRI on the same day. A T2-weighted sagittal image of the midline structures, including the symphysis, urethra, and coccyx, was obtained at rest and at maximal strain. The mobility of the bladder floor and change in the posterior urethrovesical angle were calculated for each patient. Relationships between the severity score of incontinence and mobility of the bladder floor and change in the posterior urethrovesical angle were analyzed using Spearman's rank correlation coefficients by means of SPSS.& Results: A positive correlation was found between the severity score of incontinence and the mobility of the bladder neck and also between the score and the degree of posterior urethrovesical angle (r = 0.797, P = 0.000; r = 0.62, P = 0.000, respectively). There was also a positive correlation between the severity score of incontinence and the increase in posterior urethrovesical angle during Valsalva's maneuver (r = 0.47, P = 0.02). & Conclusion: MRI is a non-invasive diagnostic method for the evaluation of bladder floor position, mobility of the bladder neck, and posterior urethrovesical angle in patients with stress urinary incontinence. It can play a major role in the postoperative follow up of stress urinary incontinence. MRI can also be used for the assessment of success in pubovaginal sling surgery.
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