Long-term efficacy of the pubovaginal Mersilene mesh sling
Department of Obstetrics and Gynecology; Department of Medicine, Division of Preventive and Behavioral Medicine
Medical Subject Headings
Adult; Aged; Aged, 80 and over; Humans; Middle Aged; *Polyethylene Terephthalates; Prospective Studies; *Suburethral Slings; *Surgical Mesh; Urinary Incontinence, Stress
Obstetrics and Gynecology
OBJECTIVE: The objective of the study was to determine the efficacy of the pubovaginal Mersilene mesh sling (PVMMS) for complicated urodynamic stress incontinence (USI).
STUDY DESIGN: 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.
RESULTS: 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).
CONCLUSION: We demonstrated PVMMS to be subjectively and objectively effective in long-term treatment of complicated forms of USI.
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Citation: Am J Obstet Gynecol. 2009 Nov;201(5):516.e1-7. Epub 2009 Sep 17. Link to article on publisher's site