13: Short-, mid-, and long-term incontinence outcomes in women undergoing mid-urethral sling procedures

Abstract

The primary aim was to compare short-, mid-, and long-term subjective treatment success in women undergoing MUS for stress urinary incontinence (SUI). Women undergoing a primary MUS between 2001 and 2009 were identified by CPT code. Eligible patients were mailed the Urinary Distress Inventory (UDI-6), Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Improvement (PGI-I), and Patient Satisfaction Questionnaire (PSQ). Patients in the long-term cohort were asked whether to undergo a MUS procedure again. Follow-up intervals were categorized as short-term (≤ 36 months), mid-term (36-70 months), and long-term (119 -200 months). Treatment success was defined as responses of “not at all” or “somewhat” to both SUI subscales on the UDI-6. Chi-squared tests for categorical variables, and analysis of variance (ANOVA) or Kruskal-Wallis for continuous variables were utilized. Logistic regression was used to examine the association between follow-up group and subjective treatment success, between short- and combined mid- and long-term follow-up groups after adjustment for covariates. Of N=896 respondents, 361 were assessed short-term (mean: 23.3±7.2 months), 251 mid-term (49.8±9.1 months), and 284 in long-term (147.9±20.6 months) follow-up. Differences were significant for age (short: 60.9±11.6, mid: 60.3 ± 12.5, long: 58.4±10.5, p=0.03), smoking status, prior prolapse surgery, and perioperative vaginal estrogen use (all p<0.05). Treatment success differed among groups: 75.4% in the short-, 62.3% mid-, and 67.0% long-term groups, p<0.01. Logistic regression showed that women with mid- or long-term follow up were nearly half as likely as their short-term counterparts to report subjective treatment success, adjusted Odds Ratio OR 0.51, 95% Confidence Interval CI, 0.36, 0.74. Median UDI-6 and PFIQ-7 scores revealed significant differences among short-, mid- and long-term follow-up, all p<0.01 (Table). Findings were similar for the PGI-I, p<0.01. Patient satisfaction was similar: “completely” and “somewhat satisfied” in 83.3% short-, 76.6% mid-, 78.2% long-term (p = 0.09) follow-up. In the long-term group, 73.1% reported they would undergo a MUS again. Subjective treatment success, post-operative symptom severity, and condition-specific QOL differed among short-, mid-, and long-term groups, with higher success and improved symptoms in the short-term group in women undergoing MUS. There is a drop to mid- and long-term success which is stable and sustained to 12 years; high satisfaction was sustained across the follow-up groups. Given the paucity of data on long-term outcomes of MUS, this information is valuable and informs to patient expectations.