Presentation Authors: Rachel Bergman*, Iryna Crescenze, Anne Cameron, Ann Arbor, MI
Introduction: Despite its utility in the non-neurogenic population, limited objective data exists regarding the efficacy of autologous pubovaginal sling (PVS) placement for management of urinary incontinence in patients with neurogenic bladder (NGB). We aim to assess long-term outcomes of PVS in neurogenic urinary incontinence.
Methods: This is a retrospective review of patients with NGB who received an autologous PVS from January 1st, 2000 - December 31st, 2017 at a single center. Patients with NGB undergoing PVS were identified from electronic medical record using CPT codes. Subjective and objective outcomes were collected including American Urologic Association Symptom Index (AUA-SI) and Incontinence Symptom Index (ISI).
Results: Thirty-one women with NGB receiving PVS were included. Patients had a mean age of 55+/-16 years and BMI of 28.7+/-7 kg/m2. Six patients (19.3%) had previously failed PVS. Preoperatively, patients were managed with clean intermittent catheterization (CIC) (64.5%), urethral catheter (16.1%), ileovesicostomy (6.4%), and suprapubic tube (SPT) (3.2%). Cross-over PVS placement technique was used in 16.1% and 67.7% had concomitant procedures including 8 augmentations, 3 ileovesicostomies, and 4 SPTs. At a mean follow-up of 36+/-24 months, 23 patients (74.2%) reported continued incontinence. Mean AUA-SI scores decreased from 14.8+/-9.8 to 9.7+/-10.3 (p=0.002), AUA-QoL from 5.0+/-1.87 to 2.9+/-2.1 (p=0.100), ISI-Severity from 17.3+/-10.1 to 10.7+/-9.5 (p=0.039), and ISI-Bother from 4.2+/-2.6 to 3.2+/-2.6 (p=0.016) (Figure 1). Four women underwent ileal conduit for persistent incontinence.
Conclusions: While most patients continued to have incontinence after PVS, significant improvement in objective measures was noted. This data is limited by a small retrospective nature of the review and further studies are needed to understand the role of PVS as a treatment option for urinary incontinence in NGB.