Stres üriner inkontinansin cerrahi teda visinde pubovajinal sling

Introduction: Pubovaginal sling is a treatment choice suggested to be performed in both types of stress urinary incontinence (SUI) with favorable outcome. The aim of this study was to analyze preoperative evaluation and postoperative follow-up of patients having pubovaginal (PVS) sling in our clinic. Material and Methods: Between March 1999 and October 2001, pubovaginal sling was performed to 35 patients diagnosed with SUI. All patients were evaluated in preoperative period with history, physical examination, cyctography, cyctometry and avarage value of 1st question of SEAPI questionnaire and postoperative period with avarage value of 1st (stress related leakage, 0-no urine loss, 1-loss with strenuous activity, 2-loss with moderate activity, 3-loss with minimal activity or gravitational leakage) question and response to 5th (urge incontinence, 0-no urge incontinence, 1-rare urge incontinence, 2-urge incontinence at least once a week, 3- urge incontinence at least once a day) question of SEAPI questionnaire. Results: Mean age and average number of birth of patients were 53.3±4.4 and 4.2±1.5 respectively. 9 patients had previous surgical operations for stress urinary incontinence and 17 patients had history of gynecologic operations. ALPP was below and above in 3 and 32 patients respectively. Only pubovaginal sling was performed to 25 patients, in 10 patients, pubovaginal sling as well as repair of cyctocele and/or rectocele was performed. In all patients allogreft fascia was used as a sling material. Mean hospitalization and follow-up period of the patients were 5.1±1.9 days and 14.4±3.3 months respectively. Evaluation with SEAPI forms in postoperative period revealed complete continence in 31(88.7%), de novo urge incontinence in 3( 8.5%) patients and persistent SUI in 1(%2.8) patient. No complication requiring another surgical intervention after surgery was observed. Discussion: Pubovaginal sling is a treatment alternative with low surgical morbidity and satisfactory results for SUI. Historically, pubovaginal sling has been reserved for cases of inrtinsic sphincter deficiency or prior surgical failure. Transvaginal needle and retropubic suspensions have been used mainly for sphincteric incontinence in associated with intrinsic sphincter deficiency. Favorable outcome of 9 patients, who previously had surgical operations for SUI and 3 patients having other type of SUI reveals that pubovaginal sling may be performed in all kinds of stress incontinence and a superior technique in comparison with the other procedures. Also, we postulate that this procedure can be performed with minimal morbidity. Persistent and de novo urge incontinence remains a vexing problem, about which the patient should be counceled preoperatively.