CAN THE ANTERIOR VAGINAL WALL REPAIRSURGERY INFLUENCE THE RESULTS OF MIDDLE URETHRAL SLING? LONG-TERMRESULTS AFTER 7 YEARS FOLLOW-UP
M. BALZARRO, E. RUBILOTTA, A.PORCARO, N. TRABACCHIN, S. BASSI, M. CERRUTO, W. ARTIBANI;
Urology,AOUI Verona, Verona, Italy.
Introduction: Stress urinaryincontinence (SUI) is a common pathological condition that cancoexists with cystocele. Few data are available to assess if thetreatment of the anterior prolapse may affect the results of the SUIsurgical treatment 1.
Objective: We assessed theinfluence of anterior vaginal wall repair in women candidate tosurgery for Stress Urinary Incontinence (SUI). The results wereevaluated after a very long-term follow-up.
Methods: Weperformed a retrospective analisis of a prospectively maintaineddatabase of 76 women treated for SUI. All the MUS were retropubic(TVT) or transobturator (TVTO). Cystocele repair was obtained byanterior colporrhaphy alone (AC) or reinforced by porcine Xenograft(Pelvisoft®) (ACP) or polypropylene mesh (ACM).
- Group 1:MUS: TVT 39% (16/41) TVTO 61% (25/41)
- Group 2: MUS:TVT 54% (19/35) TVTO 46% (16/35)
- AC (51% 18/35):TVT 61.1% (11/18) TVTO 39.9% (7/18)
- AC-P (26%9/35): TVT 77.8% (7/9) TVTO 22.2% (2/9)
- AC-M (23%8/35): TVT 22.5% (1/8) TVTO 7/8 (87.5%)
All women underwentpreoperative urodynamics. Preoperative and postoperative evaluationincluded: phisical examination, stress test and POP-Quantification,pads/day, urinalysis, voiding diary. Subjective outcomes wereevaluated with validated questionnaires and a simple question (Table1).Objective failure were: positive stress test and anterior POPstage ≥2. Chi-square or Fisher’s exact test were used forstatistical analysis.
Results: Mean follow-up was 90.6 +45.6 months. SUI recurrence rate was higher in group 1 (24.4%vs 14.3%) with no statistical significant difference (p 0.52).There was no statistical difference in objective results between TVT(46% 35/76) and TVTO (54% 41/76), p 0.25. Complicationsincluded urinary retention, granuloma, pelvic pain, extrusion of thetape. Only one case of tape extrusion was documented in a TVT ofgroup 1, this woman had a concomitant diagnosis of Papilloma Virus inthe site of extrusion. No biomesh or mesh extrusion was documented inwomen underwent anterior POP repair. In group 1 we had just onepatient, treated with TVTO, with voiding dysfunction with earlyspontaneus resolution. Voiding dysfunctions in group 2 weredocumented in 4 patients. In two cases (TVTO) we had an earlyspontaneous resolution, while in other two cases (TVT) a tapeincision was performed. Follow-up results are reported in figure 1.Considering patients who had MUS plus cystocele repair we documenteda better SUI success rate in the group where a biomesh or mesh wasused (100% 17/17) respect to the AC group (72.2% 13/18) with astatistical significant difference (p 0.045).
Conclusions:Our results show no significant influence of cystocele repair inpatients treated for SUI. However, we documented a recurrence rate10.1% higher in patients treated with the only MUS. It is possiblethat in a larger cohort this could became statistical significant.Another interesting finding was the difference (p<0.045) ofrecurrence in the sub-group of patients treated by mesh/biomeshversus the fascial repair. This result could have a twofoldexplanation: the greater support created by a mesh/biomesh at level 2of DeLancey, and the superior fibrosis effect that could create apull consequence on paraurethral tissues. The association between MUSand cystocele surgery did not increase the rate of complications. MUSobjective results are not influenced by anterior wall repair. In caseof cystocele repair the use of a bio/mesh showed better results onSUI. Patients with concomitant POP repair obtained higher subjectivesatisfaction.
References: 1. Int Urogynecol J. 2013Jul;24(7):1123-6.
Table1.Patients characteristics and outcomes.
Group2MUS+ anterior repair
Meanage, years± s.d.
N.pad/day ± s.d.
*VLPP:Valsalva Leak Point Pressure
**PPBC:Patient Perception of Bladder Condition
***PGI-I:Patient Global Impression of Improvement
Table2. Sub-analysis group 2.