Abstract

Introduction: The number of patients with stress urinary incontinence has inclined in recent years. However the gold standard surgical procedure for stress urinary incontinence is not certain yet. In this study, we evaluated urodynamic findings, clinical success and complication rates of pubovaginal vaginal wall sling procedures, namely tension free vaginal tape (TVT), vaginal wall sling (VWS) and retropubic cystourethropexy (Burch procedure).

Materials and Methods: Between February 1997 and July 2003, 70 female patients with the diagnosis of stress urinary incontinence were included into the study. VWS was performed in 28 (40%) patients while TVT was performed in 13 (18.6%) and Burch procedure in 29 (41.4%) patients. Preoperatively patient’s histories were taken briefly and urethral mobility was evaluated by physical examination. Pelvic floor relaxation was evaluated by gynecological examination. Patients with high grade pelvic floor relaxation were excluded. Water cystometry was performed in all patients. Postoperative complications and hospitalization periods were recorded. Postoperative urodynamic follow-up was performed during the first year. The comparisons of success rates between groups, differences between preoperative and postoperative parameters and the correlation of the parameters with the success rates were evaluated.

Results: Mean age was 47.5 years (range 40-63). Nine patients had history of previous anti-incontinence surgery and in seven of these patients VWS procedure was performed. Mean follow up time was 22 months (12-35 months) and the success rate was 69%, 71% and 69% in Burch, VWS and TVT groups, respectively. There were no statistically significant differences between the groups and the success rates, although VWS procedures had higher success rates in secondary cases (p=0.01).

Conclusion: Although there are many types of surgical procedures for stress incontinence, there is no consensus on the most appropriate procedure. There were no differences in the success rates among the groups but in the secondary cases the success rate was higher in the VWS group. Although VWS procedures and especially TVT, is the most commonly preferred procedure, it is emphasized that Burch which was the most carried out procedure, still has an important place particularly in primary cases.