Abstract: PD17-12
Sources of Funding: None

Introduction

To report on the mid and long term outcomes for the anterior vaginal wall suspension (AVWS) procedure for stress urinary incontinence (SUI) with early stage anterior compartment prolapse.

Methods

Following IRB approval, the long term prospective Access database of non neurogenic women who underwent AVWS for SUI and early stage anterior compartment prolapse was reviewed in women with complete pre and postoperative records and minimum 6 month follow up. Preoperative evaluation included detailed history, validated questionnaires (UDI 6, QoL), physical examination, and standing lateral voiding cystourethrogram (VCUG). Follow up included physical examination, questionnaires, and one VCUG at 6 to 12 months postoperatively. Failure was measured by Kaplan Meier curves using time to reoperation for incontinence as documented in the most recent patient encounter. Mixed effects model least square means were used for baseline versus post AVWS mean score comparison and for follow up period mean score comparison.

Results

Between 1996 and 2016, 235 patients met inclusion criteria. Median follow up was 5.3 years, with 47 (20%) patients having over 10 year follow up. Mean SD were: age 62.0 (11.0), BMI 26.0 (6.4), and parity 2.4 (1.3). 104 (44%) patients underwent AVWS alone. Among concomitant procedures, hysterectomy (LAVH) was the most common. Aa and Ba points, questionnaire results, and QoL consistently improved postoperatively and remained improved over time (Table 1). VCUG findings also improved for urethral support and cystocele reduction. Additional therapy was required in 12 (5%) patients, with sling placement (4) or injectable agents (8).

Conclusions

The AVWS procedure can durably correct SUI secondary to urethral hypermobility by restoration of anatomical support to the bladder neck and bladder base.

Funding

None