Prospective analysis of 263 women treated with the prolene sling: Surgical outcome and satisfaction determined by patient driven questionnaire
Introduction and Objectives:
Although sling procedures have been used successfully for the treatment of stress urinary incontinence (SUI), new sling materials have been pursued because of the morbidity associated with harvesting autologous fascia and the questionable durability of cadaveric fascia. We report our continued experience with the prolene sling, intermediate surgical outcome and satisfaction determined by independent patient assessment.
We prospectively evaluated 263 consecutive patients who underwent a prolene sling for the treatment of SUI. Patients had preoperative evaluation with video urodynamics, a symptom questionnaire, and cystoscopy. Postoperatively patients were evaluated at 3-month intervals with history and physical exam, voiding dysfunction/incontinence symptom questionnaire, the short form of the urogenital distress inventory (UDI-6), a validated global quality of life question and flow and residuals (PVR). Guided by the NIH terminology statement cure was defined as patient reported resolution of SUI, negative Marshals test, no pad usage and absence of adverse effects. Failure was defined as patients reporting less than 50% improvement. Patients were improved if they reported >50% improvement.
26% of patients had failed prior surgery. 45% of patients had only a sling and 14% patients had both a urethrolysis and a sling. 33% patients underwent concomitant rectocele repair, 4% enterocele repair, and 11% vaginal hysterectomy. There were no intraoperative complications, and no major postoperative complications. There was no permanent retention and no urethral erosions. 2 patients had transient urinary retention lasting 2-3 months. At a minimum of 1-year follow-up (12-24 months) 55% patients were cured with no incontinence and no pads, 3.5% failed, and the rest were >50% improved. On patient filled questionnaires the preoperative score for SUI was 2.3 (0=none, 3=severe) and postoperatively 0.5 (p<0.05), the average number of pads per day went form 2.7 to 0.9 (p<0.05). The de novo urge incontinence rate was 9%. The average postoperative global quality of life due to urinary symptoms was 1.7 (0=delighted, 6=terrible)mostly due to persistent urge incontinence. Average postoperative flow rate and PVR were 15 cc/s and 4cc.
A prolene mesh sling under the distal urethra has excellent results and patient satisfaction, and is a simple and inexpensive method to correct SUI. Further follow up is necessary.
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