FEMALE UROLOGY

The completely dry rate: a critical re-evaluation of the outcomes of slings
Kobashi KC, Govier F
Continence Center at Virginia Mason, Urology and Renal Transplantation, Seattle, Washington, USA
Neurourol Urodyn. 2005; 24: 602-5

• Objective: To critically evaluate sling outcomes and revisit the realistic goals of anti-incontinence surgery.
• Materials and Methods: A review of an Institutional Review Board-approved prospective database revealed the outcomes of four different sling techniques that are utilized at our institution.
• Results: Four hundred ninety-eight patients had a mean follow-up varying from 9 to 24 months (range 6-50) after undergoing one of four different sling techniques utilized at our institution. The techniques had similar results with regard to completely dry rate, overall success rate, and rate of urgency regardless of the variation in follow-up time. Success was defined as completely dry or leakage = 1/week or = 70% improved by questionnaire in those patients who leaked 1/week. Success, by this definition, varied from 74.9% to 85.7%, but the completely dry rate varied from 36.1% to 45.2%. An additional 31.0% to 33.3% leaked = 1/week, and of the remaining patients, 24.5% to 44.4% considered themselves = 70% improved despite leakage > 1/week. Urge incontinence was reported by 24.4% to 33.3% of patients.
• Conclusion: As surgeons, we must constantly reevaluate the outcomes and purposes of the procedures we perform on our patients.
  
  
• Editorial Comment
  The authors retrospectively reviewed the outcomes of 4 different sling techniques that they had performed in their practice. They were able to identify 498 patients with follow-up ranging from 6-15 months. Success in their patient population was well defined. The authors found a completely dry rate in the range of: 36.1 - 45.2%. Urge incontinence was reported at 24.4 - 33.3% of patients. Success in this patient population was noted to be 74.9 – 85.7%.
  This is an important paper to read in view of the large patient population, which was retrospectively analyzed, and the forthrightness of the authors’ report of their results. The authors noted that with this large population they were able to find that their completely dry rate was fewer than 50%. In addition, the urinary urge rate was also between almost one-fourth to one third of the patients studied. These < 90% completely dry rates combined with definite rates of urinary urge incontinence have been mirrored in the literature in the past by others (1). Despite the completely dry rate at < 50%, the success rate was still greater than three-fourths of patients treated. When reading this report the reader may well identify with the results noted by these surgeons as I did during my review.

Reference
1. Haab F, Trockman BA, Zimmern PE, Leach GE: Results of pubovaginal sling for the treatment of intrinsic sphincter deficiency determined by questionnaire analysis. J Urol. 1997; 158: 1738-41.

Dr. Steven P. Petrou
Associate Professor of Urology
Mayo Clinic College of Medicine
Jacksonville, Florida, USA