Urgency Incontinence before and after Revision of a Synthetic Mid-Urethral Sling

To evaluate urgency urinary incontinence outcomes for patients who underwent revision of a presumed obstructing synthetic mid-urethral sling and examine risk factors for persistent or de-novo symptoms after surgery.

From 2/1/2005 to 6/1/2013, 107 women underwent sling revision for new or worsening lower urinary tract symptoms after synthetic mid-urethral sling surgery. Patients were grouped based on urgency urinary incontinence symptoms and characteristics associated with persistent or de-novo symptoms after revision were examined using logistic regression models.

Median follow-up was 29 months (IQR13-53) and time to revision was 21 months (IQR5-48). Patients presenting for sling revision with urgency incontinence (n=68) were more likely to experience >6 months delay to revision vs. those presenting with obstructive voiding symptoms (n=39) (OR=3. 25, 95%CI:1. 33-7. 92, p<0. 01). After revision, urgency incontinence persisted in 76. 5% (52/68) and was associated with pre-revision need for anticholinergic medication (OR=5. 58, 95%CI:1. 44-21. 39, p=0. 01) and smoking (OR=5. 21, 95%CI:1. 21-22. 49, p=0. 03). De-novo urgency incontinence developed in 43. 6% (17/39) and was associated with de-novo stress incontinence (OR=15. 9, 95%CI:3. 2-78. 3, p < 0. 01). Women with post-revision urgency incontinence (de-novo or persistent) had higher UDI6 scores as opposed to patients with no or resolution of urgency incontinence respectively.

Patients presenting with new or worsening urgency urinary incontinence after sling placement were more likely to undergo delayed revision compared to those presenting with obstructive voiding symptoms. There is a high rate of bothersome persistent and de-novo urgency incontinence after sling revision. Patient expectations should be managed accordingly prior to sling revision.

The Journal of urology. 2016 Jan 25 [Epub ahead of print]

Iryna M Crescenze, Nitya Abraham, Jianbo Li, Howard B Goldman, Sandip Vasavada

Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.  Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. , Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. , Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. , Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.

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