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Mesh Sling Effective Long Term for Complicated USI


 

NEW ORLEANS — The pubovaginal Mersilene mesh sling is effective in treating complicated urinary stress incontinence and holds up as long as 15 years, based on follow-up data for 296 patients in a trial first reported on in 2001.

The goal of follow-up was to determine the short- (less than 2 years), intermediate- (2–5 years), and long-term (more than 5 years up through 18 years) objective and subjective efficacy of the mesh sling for three at-risk urinary stress incontinence (USI) subgroups, Dr. Stephen B. Young said at the annual meeting of the Society of Gynecologic Surgeons.

Overall, the objective cure rate was 89% in the 194 patients who had short-term urodynamic studies. In the 45 patients in the intermediate group, the objective cure rate was 87%, and in the 57 patients in the long-term group, it was 91% (see chart).

The subjects in the study were diagnosed with urinary stress incontinence between 1990 and 2008. The results of the initial 5-year study were published in 2001 in the American Journal of Obstetrics and Gynecology (185:32–40), with Dr. Young as the lead author.

The procedures were all performed by a single surgeon at a single institution.

The patients were followed at 1, 5, 10, and 15 years with urodynamic studies.

Of the 306 patients in the initial study, 133 (43%) had intrinsic sphincter deficiency, 82 (27%) had recurrent USI, and 91 (30%) had chronically increased intra-abdominal pressure. (Ten patients were not followed because they did not have the urodynamic studies.)

The short-term cure rate was 81% for intrinsic sphincter deficiency patients, 96% for the recurrent USI group, and 96% for the intra-abdominal pressure group. At the longer mark, cure rates were 90% for the intrinsic sphincter deficiency group, 84% for the USI group, and 100% for the intra-abdominal group, Dr. Young, chief of urogynecology and reconstructive pelvic surgery at UMass Memorial Medical Center in Worcester, reported.

The subjective cure rate was based on patients' response to question 17 on the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20), which asked whether there was leakage related to coughing, sneezing, or laughing.

Only 136 patients completed the PFDI and the short form of the Pelvic Floor Impact Questionnaire (PFIQ-17), however. Dr. Young said that he and his colleagues plan a complete analysis of the two questionnaires and of a home pad test.

And yet another study will analyze all the adverse events for the 306 patients.

Discussant Dr. Ralph Chesson, section chief of urogynecology and pelvic surgery at the Louisiana State University Health Sciences Center, New Orleans, said that the study proved that the mesh sling “had excellent short- and long-term success rates in a beautiful study.”

But he noted, just having a single surgeon somewhat weakened results.

Dr. Young said he had no disclosures to report.

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