Minimum 24-month followup of the sling for the treatment of stress urinary incontinence.

PURPOSE: The SPARC procedure is a retropubic approach for the placement of a synthetic polypropylene sling for stress urinary incontinence. Although the approach appears to be efficacious, there still exist limited long-term data. We report our experience with SPARC at a minimum followup of 24 months.

MATERIALS AND METHODS: Patients with stress urinary incontinence undergoing a SPARC sling procedure were entered into a prospective, institutional review board approved database. Postoperatively patients were asked to complete quality of life questionnaires at 6 months and annually thereafter. Success was defined by questionnaire response of 1 or fewer stress urinary incontinence episode per week or greater than 70% subjective improvement in those with greater than 1 stress urinary incontinence episodes per week.

RESULTS: A total of 307 patients were identified during a 5-year period, of whom 280 were more than 24 months from surgery. Of the patients 154 (55%) had questionnaire followup at 24 months or greater from surgery (mean 36, median 36, range 24 to 49). Mean Valsalva leak point pressure in this subset of patients was 66 cm H(2)O (median 63, range 15 to 175). Of the patients 106 (68.8%) reported 1 or greater stress urinary incontinence episodes per week and 11 (7.1%) reported greater than 70% subjective improvement despite greater than 1 stress urinary incontinence episodes per week. Based on these definitions 75.9% of the cases were considered successful.

CONCLUSIONS: The antegrade polypropylene mid urethral sling appears effective and most patients are satisfied with the outcome. The ease and minimally invasive nature of this technique does not preclude significant complications. Nevertheless, results in this series are competitive with those of other available surgical options.