Medium-term follow-up of the intravaginal slingplasty operation indicates minimal deterioration of urinary continence with time

An assessment of the medium term efficacy of stress incontinence cure in a group of patients who had undergone the intravaginal slingplasty (IVS) operation is presented. Eighty-five unselected patients, aged 27 to 83 years at the time of surgery, 12 with pure stress symptoms, and 73 with mixed incontinence symptoms underwent the IVS procedure between 31 and 57 months previously (mean 3.9 pears). The patients were assessed with the same self-administered semiquantitative questionnaire used in the initial assessment. The results were compared with the original cure rate which was 88% at 1.75 years with another 2.5% more than 70% improved (total 90.5%). The cure rate in the 75 patients assessed at 3.9 years was 81%, with another 8% reporting more than 70% improvement (total 89%). Included in the latter were 2 patients who, though originally designated as failures, gradually achieved almost 100% continence within 2 years of surgery. Deterioration of continence following the IVS operation appears more like the Burch colposuspension than needle suspensions. It is possible to explain deterioration of continence with time in terms of age-related connective tissue laxity of the vaginal hammock. Improvement in 2 women with time can be explained by tightening of the hammock via paraurethral scar contraction with time. Whether the IVS operation improves or deteriorates in the longer term may depend on which process predominates.