Long-term clinical and urodynamic evaluation of the polytetrafluoroethylene suburethral sling for treatment of genuine stress incontinence.

OBJECTIVE: To assess long-term clinical and urodynamic outcomes of suburethral sling procedures using polytetrafluoroethylene grafts.
METHODS: Between January 1986 and May 1991, 108 women underwent suburethral sling placement to treat genuine stress incontinence. At least 1 year after surgery, 62 women participated in a telephone interview about surgical outcome and completed a follow-up urodynamic evaluation.
RESULTS: Seventy-three percent of patients reported stress incontinence cure and 61% were objectively cured. Neither low urethral closure pressure nor a history of multiple prior anti-incontinence procedures, singly or in combination, adversely affected outcome. Postoperative maximum urethral closure pressure and functional urethral length were significantly greater in patients who were cured of their incontinence than in those whose surgery failed. Patients who were cured had higher amplitude detrusor contractions during micturition and greater post-void residual urine than those who were not cured. Thirty-three percent of patients with urodynamically stable bladders preoperatively developed detrusor instability after surgery. Detrusor instability remitted after surgery in half of the patients who had this condition preoperatively. Postoperative wound complications developed in 40% of patients who underwent sling placement, and 22% of the grafts were eventually removed.
CONCLUSION: Polytetrafluoroethylene suburethral sling placement is an effective treatment for stress incontinence and low urethral pressure. Urodynamic data suggest that urethral obstruction is responsible for surgical cure. Patients should be warned of the high complication rate for this suburethral sling procedure and that graft removal may be necessary.