A Randomized Controlled Trial of Pubovaginal Sling ver sus Vaginal Wall Sling for Stress Urinary Incontinence
WIT VISESHSINDH, MD*, WACHIRA KOCHAKARN, MD*, WARAPORN WAIKAKUL, MD**, UBOLRAT ROONGRUANGSILP, BSc, MSc***, NICHA SIRIPORNPINYO, BSc, MA***, VIRA VISESHSINDH, MD*
Affiliation : *Division of Urology, Department of Surgery, **Department of Anesthesiology, *** Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Purpose : To compare the results of Pubovaginal sling and Vaginal wall sling for the treat ment of stress urinary incontinence in females.
Materials and Methods : Between February 2001 and December 2001, a randomized controlled trial was done to compare safety and efficacy of pubovaginal sling versus vaginal wall sling in the management of women with urinary incontinence. Fifteen women 42-68 years old (mean age 51.3 years) were treated with fascial sling (group A) and 11 women 45-60 years old (mean age 50.4 years) with vaginal wall sling (group B). Twenty-one patients had type II SUI and 5 patients had type III SUI (ISO); none had pre-operative detrusor instability. Measures of outcome included efficacy based on SEAPI-QMN, post-operative presence of stress or urge incontinence, frequency of complications, operative time, post-operative pain, length of hospitalization, length of clean intermittent catheteriza tion (CIC) time and mean global evaluation.
Results : All patients were followed for at least 3 months after surgery (median 7 months). A total of 20 and 6 women received spinal and general anesthesia, respectively. SEAPI-QMN decreased from a median of 6.3 to 0.8 for group A and from 6.1 to 0.9 for group B. No patient in either group had persistent stress incontinence. Urge incontinence was present in 2 of group A patients and 1 of group B patients. No serious post-operative complications were encountered in both groups. Post-operative pain and operative times for group B patients were significantly lower than for group A patients. Length of hospitalization, length of CIC time and mean global evaluation were not significantly different between the two groups.
Conclusion : In the short-term, both pubovaginal sling and vaginal wall slings were effective in the treatment of women with SUI. However, the use of vaginal wall sling resulted in significantly shorter operative times and lower post-operative pain compared with pubovaginal sling. Therefore, the vaginal wall sling should be the prefered treatment for SUI.
Keywords : Stress Urinary Incontinence, Surgery, Pubovaginal Sling, Vaginal Wall Sling, Ran domized Controlled Trial
