Two-Year Outcomes after Surgery for Stress Urinary Incontinence in Older Versus Younger Women

 

Introduction and Objective

Determine if peri- and postoperative outcomes after Burch colposuspension or pubovaginal sling for stress urinary incontinence (SUI) differed with age.

Methods

Prospective secondary analysis of the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr). Baseline characteristics, adverse events and two-year outcomes of women ≥65 years old were compared to those <65 utilizing Chi-square and t-tests. Multivariable analyses were performed, including age and outcomes that differed between age groups on bivariate analysis, adjusting for variables that differed by age group at baseline and by surgical treatment group.

Results

655 women were included in analyses of peri-operative events and 554 for 2-year outcomes. Mean age (±SD) was 69.7(±3.7) years in the older group and 49.4(±8.2) in the younger group. Older women had slightly longer time to normal activities [50 versus 42 days, p=0.05], but no difference in time to normal voiding [14 versus 11 days, p=0.42]. Older women were more likely to have a positive stress test at follow-up (OR 3.8, 95% CI 1.78-8.27, p<.001), less subjective improvement in stress (8 point lesser decrease, 95%CI: 2.3-14.5, p=0.007) and urge (7 point lesser decrease, 95%CI 1.8-12.2, p=0.008) incontinence by the Medical and Epidemiologic Social Aspects of Aging questionnaire, and were more likely to undergo surgical retreatment for SUI (OR 3.1, 95% CI 1.34-6.97). Perioperative adverse events and length of stay did not differ between groups.

Conclusion

Older women undergoing surgery for stress incontinence can expect to do as well as younger women with respect to perioperative outcomes, but experience worse 2-year outcomes.

Keywords

Surgical outcomes, older versus younger women, stress urinary incontinence, reduced benefit in older women

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