Expanded indications for the pubovaginal sling: Treatment of type 2 or 3 stress incontinence

Purpose: The usefulness of the pubovaginal sling procedure as primary treatment of stress incontinence associated with urethral hypermobility (type 2) or intrinsic sphincter deficiency (type 3) was determined. Materials and Methods: A total of 60 consecutive cases of type 2 or 3 stress urinary incontinence was treated with a pubovaginal sling by 1 surgeon using a previously reported technique. Fluoroscopic urodynamic studies with leak point pressures were used to classify the type of incontinence. Of the 60 women 38 (63%) were diagnosed with type 2 and 22 (37%) with type 3 stress urinary incontinence. Of these patients 24 had previously undergone 1 or more anti-incontinence procedures. Results: At a mean followup of 25 months 57 of the 60 patients (95%) were completely continent. In addition, 69% of patients with urgency had resolution of the urgency symptoms following the sling procedure. Transient postoperative urinary retention (median duration 6.5 days) was present in 60% of the patients. However, all women subsequently voided spontaneously without requiring further intermittent or Foley catheterization. Other complications occurred infrequently, and included urinary tract infection (13% of cases), de novo urgency (12%) and persistent incisional pain (5%). Conclusions: These early results suggest that the pubovaginal sling is a safe and effective treatment for primary or recurrent type 2 or 3 stress incontinence. The most worrisome complication, urinary retention, occurred temporarily in more than half of the patients but eventually resolved in all cases, usually within 10 days.