International Urogynecology Journal

, Volume 26, Issue 3, pp 427–432 | Cite as

Midurethral slings versus the standard pubovaginal slings for women with neurogenic stress urinary incontinence

Original Article
First Online:
Received:
Accepted:

Abstract

Introduction and hypothesis

Preliminary reports show promising data on tension-free vaginal tape (TVT) in women with lower motor neuron lesion (LMNL) presenting with stress urinary incontinence (SUI). We compared efficacy and safety of TVT to pubovaginal sling (PVS) in treating SUI in women with LMNL.

Methods

This was a pilot, nonrandomized clinical trial evaluating women with SUI associated with pathology at or below S2 spinal segment. Failure was defined as leakage of urine during cough test at 250 ml bladder volume. Primary outcome was time to treatment failure based on positive cough stress test. Other outcomes were Urogenital Distress Inventory Short Form-6 (UDI-6), Incontinence Impact Questionnaire Short Form-7 (IIQ-7) and urodynamics. Regression models were used to adjust for confounders.

Results

The study evaluated 40 women: 20 TVT and 20 PVS, and cure rates were 80 and 85 %, respectively. Time to treatment failure in the TVT group was comparable with the PVS group, with an unadjusted hazard ratio (HR) of 2.90 [95 % confidence interval (CI), 0.61–15.42, P = 0.154]. After adjusting for confounders, adjusted HR for treatment failure was 1.04 (95 % CI, 0.12–8.66, likelihood ratio chi-square P = 0.973). Both groups showed significant reductions in UDI-6 and IIQ-7 scores after surgery. One patient had mesh erosion in the TVT group.

Conclusions

TVT is feasible, effective and safe for women with LMNL presenting with SUI, with comparable treatment outcomes to PVS. TVT might be of benefit to women who do not use clean intermittent catheterization (CIC) at baseline.

Keywords

Neuropathic bladder Spinal cord injury Stress incontinence Tension-free vaginal tape 

Abbreviations

TVT

tension-free vaginal tape

PVS

Pubovaginal Sling

nSUI

neurogenic stress urinary incontinence

UDI-6

Urogenital Distress Inventory Short Form−6

IIQ-7

Incontinence Impact Questionnaire Short Form−7

PVR

postvoid residual urine volume

CIC

Clean intermittent self catheterization

This is a preview of subscription content, log in to check access.

Notes

Conflicts of interest

None.

References

  1. 1.
    Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26CrossRefPubMedGoogle Scholar
  2. 2.
    El-Azab AS, Mohamed EM, Sabra HI (2007) The prevalence and risk factors of urinary incontinence and its influence on the quality of life among Egyptian women. Neurourol Urodyn 26:783–788CrossRefPubMedGoogle Scholar
  3. 3.
    Delancey JO (2002) Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 187:93–98CrossRefPubMedGoogle Scholar
  4. 4.
    Petros PE (1998) The pubourethral ligaments–an anatomical and histological study in the live patient. Int Urogynecol J Pelvic Floor Dysfunct 9:154–157Google Scholar
  5. 5.
    Harrop JS, Hunt GE Jr, Vaccaro AR (2004) Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles. Neurosurg Focus 16:e4CrossRefPubMedGoogle Scholar
  6. 6.
    Fidas A, MacDonald HL, Elton RA et al (1988) Neurophysiological measurements in patients with genuine stress incontinence of urine and the relation of neurogenic defects to the presence of spina bifida occulta. Br J Urol 62:46–50CrossRefPubMedGoogle Scholar
  7. 7.
    Watanabe T, Chancellor MB, Rivas DA (1998) Neurogenic voiding dysfunction. In: Nitti VW (ed) Practical Urodynamics. W.B. Saunders Company, Philadelphia, pp 142–146Google Scholar
  8. 8.
    Daneshmand S, Ginsberg DA, Bennet JK et al (2003) Puboprostatic sling repair for treatment of urethral incompetence in adult neurogenic incontinence. J Urol 169:199–202CrossRefPubMedGoogle Scholar
  9. 9.
    De Vocht TF, Chrzan R, Dik P et al (2010) Long-term results of bulking agent injection for persistent incontinence in cases of neurogenic bladder dysfunction. J Urol 183:719–723CrossRefPubMedGoogle Scholar
  10. 10.
    Chartier-Kastler E, Van Kerrebroeck P, Olianas R et al (2011) Artificial urinary sphincter (AMS 800) implantation for women with intrinsic sphincter deficiency: a technique for insiders? BJU Int 107:1618–1626CrossRefPubMedGoogle Scholar
  11. 11.
    Austin PF, Westney OL, Leng WW et al (2001) Advantages of rectus fascial slings for urinary incontinence in children with neuropathic bladders. J Urol 165:2369–2371CrossRefPubMedGoogle Scholar
  12. 12.
    Gormley EA, Bloom DA, McGuire EJ et al (1994) Pubovaginal slings for the management of urinary incontinence in female adolescents. J Urol 152:822–825PubMedGoogle Scholar
  13. 13.
    Chung E, Cartmill RA (2010) 25-year experience in the outcome of artificial urinary sphincter in the treatment of female urinary incontinence. BJU Int 106:1664–1667CrossRefPubMedGoogle Scholar
  14. 14.
    Hamid R, Khastgir J, Arya M et al (2003) Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders. Spinal Cord 41:118–121CrossRefPubMedGoogle Scholar
  15. 15.
    Abdul-Rahman A, Attar KH, Hamid R et al (2010) Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders. BJU Int 106:827–830CrossRefPubMedGoogle Scholar
  16. 16.
    El-Azab AS, Mascha EJ (2009) Arabic validation of the urogenital distress inventory and adapted incontinence impact questionnaires-short forms. Neurourol Urodyn 28:33–39CrossRefPubMedGoogle Scholar
  17. 17.
    Schafer W, Abrams P, Liao L et al (2002) Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21:261–274CrossRefPubMedGoogle Scholar
  18. 18.
    Chaikin DC, Rosenthal J, Blaivas JG (1998) Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol 160:1312–1316CrossRefPubMedGoogle Scholar
  19. 19.
    Lee E, Nitti VW, Brucker BM (2012) Midurethral slings for all stress incontinence: a urology perspective. Urol Clin N Am 39:299–310CrossRefGoogle Scholar
  20. 20.
    Athanasopoulos A, Gyftopoulos K, McGuire EJ (2012) Treating stress urinary incontinence in female patients with neuropathic bladder: the value of the autologous fascia rectus sling. Int Urol Nephrol 44:1363–1367CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  1. 1.Section of Female Urology and NeuroUrologyAsyut University Urology HospitalAsyutEgypt
  2. 2.Department of Obstetrics and Gynecology, Mayo ClinicRochesterUSA

Personalised recommendations