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• W2012033907 abstract "No AccessJournal of UrologyAdult Urology: Voiding Dysfunction1 Apr 2005CADAVERIC PROLAPSE REPAIR WITH SLING: INTERMEDIATE OUTCOMES WITH 6 MONTHS TO 5 YEARS OF FOLLOWUP ROBERT W. FREDERICK and GARY E. LEACH ROBERT W. FREDERICKROBERT W. FREDERICK More articles by this author and GARY E. LEACHGARY E. LEACH Financial interest and/or other relationship with Mentor, Boston Scientific and AMS. More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000155168.98462.81AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present the prospective, intermediate-term results for cadaveric prolapse repair with sling as combined treatment of stress urinary incontinence and cystocele. Materials and Methods: A total of 251 of 295 (85%) patients undergoing cadaveric prolapse repair with sling (CaPS) had at least 6 months of questionnaire and pelvic examination followup. All patients had objectively demonstrated stress urinary incontinence and grade 2 to 4 cystocele before surgery. Followup outcome measures included a validated subjective continence and patient satisfaction questionnaire, SEAPI (stress incontinence, emptying, anatomy, protection, inhibition) scores, pelvic examination for prolapse recurrence and complications, and quality of life scores. Results: The overall patient reported subjective incontinence cured/dry rate (no incontinence episodes of any type) was 114 of 251 (45%), the cured/improved rate (50% improvement or greater) was 192 of 251 (76%) and the failed rate (less than 50% improvement) was 59 of 251 (24%). When considering stress urinary incontinence the cured/dry rate was 141 of 251 (56%), cured/improved rate was 207 of 251 (82%) and failed rate was 44 of 251 (17.5%), with 17 of the 44 (39%) cases having mixed urinary incontinence. Of the 59 failures 33 (56%) occurred after 12 months of followup. Of 153 patients 13 (8.5%) experienced de novo urge incontinence. The symptomatic cystocele recurrence rate was 18 of 251 (7%). There were statistically significant improvements in SEAPI and prolapse quality of life scores. Of 251 patients 200 (80%) were at least 50% satisfied and of 251 193 (77%) stated they would undergo the CaPS procedure again. Conclusions: With a maximum followup of 5 years in patients undergoing CaPS, we have seen excellent, durable cystocele repair results. While our subjective continence rates have decreased with an increasing number of late failures, we continue to observe significant improvement in SEAPI scores and quality of life with good patient satisfaction and low morbidity. References 1 : A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS). Urology2000; 56: 9. Google Scholar 2 : Surgical Repair of Vaginal Defects. Philadelphia: J. B. Lippincott1992. Google Scholar 3 : Results of pubovaginal sling for the treatment of intrinsic sphincteric deficiency determined by questionnaire analysis. J Urol1997; 158: 1738. Link, Google Scholar 4 : SEAPI QMM Incontinence classification system. Neurourol Urodyn1992; 11: 187. Google Scholar 5 : Development of validated quality of life assessment instrument for patients with pelvic prolapse. J Urol2000; 163: 76. abstract 334. Google Scholar 6 Zimmern P.E., Leach G.E., Ganabathi K.: The urological aspects of vaginal wall prolapse, Part 1. Diagnosis and surgical indications. AUA Update Series, vol. XII, lesson 25, p. 193, 1993 Google Scholar 7 : Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstet Gynecol1997; 89: 311. Google Scholar 8 : Tissue strength analysis of autologous and cadaveric allografts for the pubovaginal sling. Neurourol Urodyn1999; 18: 497. Google Scholar 9 : Use of cadaveric solvent-dehydrated fascia lata for cystocele repair—preliminary results. Urology2001; 58: 179. Google Scholar 10 : Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach. Am J Obstet Gynecol1978; 131: 203. Google Scholar 11 : Incidence of recurrent cystocele after anterior colporrhaphy with and without concomitant transvaginal needle suspension. Am J Obstet Gynecol1996; 175: 1476. Google Scholar 12 : Surgical management of prolapse of the anterior vaginal segment: an analysis of support defects, operative morbidity, and anatomic outcome. Am J Obstet Gynecol1994; 171: 1429. Google Scholar 13 : Paravaginal defect repair in the treatment of female stress urinary incontinence and cystocele. Urology1999; 54: 647. Google Scholar 14 : Technique of combined pubovaginal sling and cystocele repair using a single piece of cadaveric dermal graft. Urology2002; 59: 538. Google Scholar 15 : Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol1998; 160: 1312. Link, Google Scholar 16 : Pubovaginal sling: 4-year outcome analysis and quality of life assessment. J Urol2000; 163: 1845. Link, Google Scholar 17 : Long-term results of tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct2001; 12: S5. Google Scholar 18 : The effect of study methodology on reported success rates of the modified Pereyra bladder neck suspension. J Urol1995; 154: 1732. Link, Google Scholar 19 : Prospective analysis of patients treated with a distal urethral polypropylene sling for symptoms of stress urinary incontinence: surgical outcome and satisfaction determined by patient driven questionnaires. J Urol2003; 170: 857. Link, Google Scholar 20 : Efficacy and morbidity of autologous fascia lata sling cystourethropexy. J Urol2004; 171: 1180. Link, Google Scholar From the Tower Urology Institute for Continence, Los Angeles, California© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byRapp D and Kobashi K (2018) Outcomes Following Sling Surgery: Importance of Definition of SuccessJournal of Urology, VOL. 180, NO. 3, (998-1002), Online publication date: 1-Sep-2008. Volume 173Issue 4April 2005Page: 1229-1233 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsprolapseoutcome assessment (health care)urinary incontinencefascia latabladderMetricsAuthor Information ROBERT W. FREDERICK More articles by this author GARY E. LEACH Financial interest and/or other relationship with Mentor, Boston Scientific and AMS. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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