Long-term efficacy of the pubovaginal Mersilene mesh sling
Presented at the 35th Annual Scientific Meeting of the Society of Gynecologic Surgeons, New Orleans, LA, March 30-April 1, 2009.
Received 29 December 2008; received in revised form 21 May 2009; accepted 1 July 2009. published online 18 September 2009.
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.
1Department of Obstetrics and Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA
2Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA
3Department of Pediatrics, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA
4Department of Obstetrics and Gynecology, United States Army
Reprints: Stephen B. Young, MD, Professor of Obstetrics and Gynecology, UMass Memorial Medical Center, Division of Urogynecology and Reconstructive Pelvic Surgery, 119 Belmont St, Worcester, MA 01605
Cite this article as: Young SB, Howard AE, Illanes DS, et al. Long-term efficacy of the pubovaginal Mersilene mesh sling. Am J Obstet Gynecol 2009;201:516.e1-7.
This study was supported in part by the Department of Obstetrics and Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA.
The views expressed herein are those of the authors and do not necessarily represent the opinion of the Armed Forces.
ABSTRACT