Fascial Mild Urethral Sling or Artificial Urinary Sphincter in the Neurological Women Population, a Multicenter Study

Background: Achieving continence in patients with neurogenic bladder is a difficult goal especially when stress urinary incontinence (SUI) due to intrinsic sphincter deficiency is involved. Two techniques are commonly used in that setting, but they have never been directly compared: the artificial urinary sphincter (AUS) and the fascial pubovaginal sling (PVS). The present study aims to compare the outcomes of AUS and PVS in female neuropathic patients. Methods: This retrospective international multicenter study was conducted from 2014 to 2023. We included all women with a past medical history of neurogenic bladder who underwent AUS or a PVS insertion (cadaveric or fascia lata) at three centers. The primary endpoint was the outcomes as assessed by the patient global impression of improvement (PGII) at 3 months and at the last follow-up. Results: Thirty-five patients were included: 16 with AUS and 19 with PVS. The PVS patients had fewer previous anti-incontinence procedures (10.5% vs. 43.8%; p = 0.02). The maximum cystometric capacity was significantly higher in the AUS group (364.1 vs. 252.8 mL; p = 0.03). All perioperative outcomes were similar in both groups with only two major postoperative complications in each group (12.5% vs. 10.5%; p = 0.99). Many functional outcomes favored AUS, but with no statistically significant difference, except for PGII = very much improved at 3 months (68.8% vs. 31.6%; p = 0.04). Conclusion: AUS and PVS are two procedures yielding satisfactory outcomes in the female neurogenic SUI population, with similar morbidity. The functional outcomes may be more favorable with AUS.