In a recent updated systematic review of 39 randomized controlled trials comparing different SUI procedures, midurethral slings and pubovaginal slings
had similar cure rates.
In our opinion, the autologous pubovaginal sling
is appropriate for patients with SUI who decline to have synthetic material implanted because of concerns related to long-term placement of synthetic mesh.
18) Some surgeons prefer the placement of a fascial pubovaginal sling
in patients who have failed a prior synthetic MUS, although consistent data is lacking in the literature.
Richter acknowledged that there is a growing trend toward the use of midurethral slings for the treatment of SUI, but noted that "there are still a significant number of surgeons that adhere to using the gold standard Burch and pubovaginal sling
," both nationally and worldwide.
The sling is installed loosely without any of the fussing over appropriate sling tension entailed in traditional pubovaginal sling
As for bladder perforation, in the study comparing the pubovaginal sling
, TVT, and TOT for stress urinary incontinence with ISD, (1) no perforation was reported in a total of 92 TVT procedures.
Luis Sanz, director of the Urogynecology and Vaginal Reconstruction Clinic at Georgetown University Hospital, Washington, questioned the investigators' assumption that all of the patients would be treated with a pubovaginal sling
Options can include placement of a second synthetic MUS or an autologous sling, such as a pubovaginal sling
the traditional pubovaginal sling
(PVS), placed at the bladder neck (FIGURE ["D"]).
Half of all women who fail treatment for urinary incontinence with pubovaginal sling
surgery may be cured by repeating the sling procedure, results of a small trial suggest.
Food and Drug Administration (FDA) and Health Canada about the safety of vaginal surgery using mesh implants, including the MUS, urologists and gynecologists should be familiar with suitable alternatives, including the pubovaginal sling
(PVS), which often incorporates autologous fascia.
For patients with ISD, the pubovaginal sling
and retropubic TVT remain the treatments of choice
Intense inflammatory reaction with porcine small intestine submucosa pubovaginal sling
or tape for stress urinary incontinence.
Of 655 women in the trial, 326 were randomly assigned to undergo placement of an autologous rectus fascia pubovaginal sling
, and 329 were randomized to Burch colposuspension.
Miller and colleagues reviewed records of 98 women who had undergone pubovaginal sling
to determine which urodynamic parameters best predicted postoperative voiding dysfunction.