BERKELEY, CA (UroToday.com) - Patients who develop de novo postoperative urge incontinence, report extremely low satisfaction after the surgery ¹. Currently there is no means to identify patients at increased risk of development of de novo urge urinary incontinence after surgery for stress urinary incontinence. We examined a consecutive series of women who underwent midurethral sling placement in an attempt to determine which, if any, clinical characteristics or urodynamic parameters are associated with and possibly predictive of postoperative de novo urge urinary incontinence ². De novo urge urinary incontinence was defined as the development of the symptom of new urge urinary incontinence postoperatively in subjects who did not report symptoms of urge urinary incontinence preoperatively, and who did not demonstrate detrusor overactivity on their preoperative conventional urodynamic evaluation. The analysis revealed a 27% rate of de novo post-operative urge urinary incontinence. The following UDS parameters: maximum bladder capacity, volume at the first desire to void, volume at the strong desire to void, maximum flow rate, and MUCP were not associated with increased rates of post-operative urge urinary incontinence. Multinomial logistic regression model yielded only one significant risk factors for the development of de novo urge urinary incontinence on preoperative history: increased daytime frequency of urination (p=0.008) and the following UDS parameter: detrusor pressure during the filling phase of cystometry >15cmH2O (p=0.004). Additionally, no difference in the incidence of de novo urge urinary incontinence was observed between two midurethral sling delivery systems utilized for the procedures: TVT (Gynecare, Ethicon, Johnson & Johnson, Somerville, New Jersey) vs. SPARC sling (AMS, Minnetonka, Minnesota). Based on our results, we conclude that patient’s preoperative history is only minimally useful in the identification of women at increased risk for the development of de novo urge urinary incontinence, with the exception of complaint of increased daytime frequency. The finding of increased detrusor pressure during the filling phase of cystometry on preoperative conventional urodynamics in particular, may help identify women at increased risk for postoperative de novo urge incontinence following minimally invasive midurethral sling procedure. Identification of patients at increased risk of developing de novo urge urinary incontinence would help to individualize preoperative counseling regarding expected outcomes.

References:
1. McGuire EJ, Letson W, Wang S. Transvaginal urethrolysis after obstructive urethral suspension procedures. J Urol 1989; 142:1037-8.
2. Alperin M, Abraham-Gessel S, Wakamatsu M. Development of De Novo Urge Incontinence in Women Post Sling: the Role of Preoperative Urodynamics in Assessing the Risk. Neurourol Urodynam (Published Online: Nov 5 2007)

Written by
Marianna Alperin, MD MSc, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Development of De Novo Urge Incontinence in Women Post Sling: The Role of Preoperative Urodynamics in Assessing the Risk - Abstract

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