The Anterior Vaginal Wall Suspension Procedure: Mid-Term Follow-Up of a Native Tissue Vaginal Repair for Stress Urinary Incontinence

Abstract

Objective: To report the outcomes of the anterior vaginal wall suspension (AVWS) procedure for stress urinary incontinence (SUI). Materials and Methods: Following institutional review board approval, a long-term pelvic organ prolapse database of non-neurogenic patients who underwent AVWS for bothersome SUI and ≤ stage 2 anterior vaginal compartment laxity was reviewed. Any patient with prior SUI surgery or < a 6-month follow-up were excluded. Preoperative evaluation included detailed history, validated questionnaires [Urogenital Distress Inventory-Short form, visual analog quality of life score (QoL)], physical examination, and standing lateral voiding cystourethrogram (VCUG). Follow-up included VCUG at 6-12 months postoperatively, yearly examinations, and questionnaires. Failure was measured by a Kaplan-Meier curve using time to reoperation for SUI. Results: Between 1996 and 2016, 171 patients met the study criteria. The median follow-up was 4.2 years, with 26 (15%) patients having over a 10-year follow-up. Median (interquartile range): age 64 (53-70), body mass index 26 (22-30), and parity 2 (2-3). Ninety-one (53%) patients underwent AVWS with a concomitant procedure, hysterectomy being the most common. Aa and Ba points, questionnaire results, and QoL improved post-operatively and remained improved over time. VCUG findings also improved for urethral support and bladder base reduction. SUI reoperation occurred in 9 (5%) patients, including: fascial sling placement (3) or injectable agents (6). Conclusion: The AVWS procedure can correct SUI secondary to urethral hypermobility by restoration of the vaginal anatomic support to the bladder neck and bladder base.