Department of Urogynaecology, Mercy Hospital for Women, Heidelberg. Vic., Australia. Department of Urogynaecology, Monash Medical Centre, Moorabin, Vic., Australia; Department of Urology, Assaf Harofeh Medical Centre, Zeriffin, Israel.
To determine risk factors for persistence of urgency or urge urinary incontinence following midurethral sling surgery.
Design: Prospective cohort study.
Setting: Tertiary referral Urogynaecology Unit.
A total of 754 consecutive women with stress urinary incontinence (SUI) and urgency; and 514 women with SUI and urge urinary incontinence (UUI) who underwent midurethral sling with a mean follow up of 50 months.
Women with persistent urgency or UUI at long-term follow up were compared with those whose symptoms had resolved, using multivariate analysis to determine the risk factors for persistent symptoms.
Main outcomes measures: Odd ratios (OR) of independent risk factors for persistent urgency or UUI.
Persistent urgency (304/754, 40%) and UUI (166/514, 32%) were common. Coexistent detrusor overactivity (OR 2.04, 95% CI 1.39-3.01), baseline symptom severity (OR 1.41, 95% CI 1.10-1.78) and age (OR 1.03, 95% CI 1.02-1.04) increased the risk of persistent urgency, while transobturator sling surgery (OR 0.61, 95% CI 0.39-094) and concomitant prolapse surgery (OR 0.54, 95% CI 0.38-0.75) decreased the risk. For UUI detrusor overactivity (OR 1.86, 95% CI 1.18-2.93), baseline symptom severity (OR 1.88, 95% CI 1.38-2.56), previous incontinence surgery (OR 2.18, 95% CI 1.28-3.70) increased the risk of persistence, whereas apical prolapse surgery (OR 0.33, 95% CI 0.15-0.70) decreased the risk. Women were more likely not to recommend surgery when they experienced persistent urgency (15.8% versus 2.7%, P < 0.0001) or UUI (24.7% versus 2.9%, P < 0.0001).
Urodynamic parameters, baseline urgency symptom severity, midurethral sling route and concomitant prolapse operation are important predictors of persistent urgency or UUI following midurethral sling.
Written by:
Lee JS, Dwyer P, Rosamilia A, Lim Y, Polyakov A, Stav K.
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Reference: BJOG. 2011 Mar 10. Epub ahead of print.
doi: 10.1111/j.1471-0528.2011.02915.x
PubMed Abstract
PMID: 21392244
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