ABSTRACT

Objectives:

In the present study, we evaluated the effect of apical suspension of the vagina on urinary incontinence by replacing both uterosacral ligaments with polyvinylidene-fluoride (PVDF) structures.

Materials and Methods:

All patients had stress and urgency urinary incontinence (mixed urinary incontinence). These PVDF-structures were sutured to the cervical stump (after supracervical hysterectomy) or to the vaginal vault according to the standardized cervicosacropexy (CESA) or vaginosacropexy (VASA) technique. The length of PVDF-structures in patients who underwent CESA and VASA was 8.8 cm and 9.3 cm, respectively.

Results:

In total 39% and 33% of the patients who underwent CESA or VASA became continent, respectively. Stress-related and urgency symptoms disappeared in all patients. The number of patients who became continent with these suspensions decreased with the increasing age, particularly in those aged >60 years. The age-dependent decrease in continence rates was significant among patients who underwent CESA. The percentage of patients in the <60-years and >60-years-of-age groups who became continent after CESA was 50% and 26%, respectively (p=0.002). In patients who underwent VASA, the respective continence rates were 41.5% (<60-years-of-age group) and 28.9% (>60-years-of-age group) (p=0.100).

Conclusion:

Patients who still exhibited mixed urinary incontinent were then offered a transobturator tape (TOT) procedure, following which the continence rates ranged between 40.4% and 43.3%.

Patients with mixed urinary incontinence are usually treated with different medical methods, which provide a limited success rate. The results of our study demonstrated that a bilateral apical fixation of the vaginal apex either alone or in combination with a suburethral TOT procedure was effective in treating and restoring urinary continence in 56% and 87% of patients aged >60 and <60 years, respectively.