Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women

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Surgery for stress urinary incontinence (SUI) has high success rates and high levels of patient satisfaction as well as durability. However, a high proportion of patients seeking surgery for incontinence have mixed urinary incontinence (MUI) with symptoms of overactive bladder (OAB). The urgency component of OAB is a risk factor for treatment failure and reduced satisfaction. The primary aim of this study was to assess changes in OAB symptoms following incontinence surgery from 1 to 5 years postoperatively and to identify associated predictors of change from baseline. The investigators conducted a secondary analysis of previously unreported data from 3 multicenter SUI surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The main study outcome was a 70% or greater improvement in OAB symptoms from baseline measured by the Urinary Distress Inventory–Irritative subscale. The treatment effect of each surgical type over time was assessed with generalized linear models fit using 1-year and up to 5-year data. None of the trials had a control group. One year after surgery, each SUI procedure group reported significant improvement in Urinary Distress Inventory–Irritative scores (P < 0.001). Improvement in OAB symptoms were reported by most women (50%-71%). Similar improvements occurred among patients in the retropubic midurethral sling groups and those in midurethral transobturator sling groups at 1 year (65.5% vs 70.7%, respectively; odds ratio, 0.83; 95% confidence interval, 0.57–1.20; P = 0.32) and throughout the 5-year follow-up period. More women in the Burch group reported improvement in OAB symptoms at 1 year than in the fascial sling group (67.9% vs 56.6%); the odds ratio was 1.59, with a 95% confidence interval of 1.10 to 2.31, P = 0.01. This group difference at 1 year was maintained throughout the 5-year follow-up (P = 0.02). At 1 year, the proportion of patients in all groups achieving 70% or greater improvement in UI ranged from 50.0% to 64.3%. Over the 5-year study period, this proportion declined gradually to 36.5% to 54.1%, which was still a statistically significant level of improvement (P < 0.001). Potentially relevant clinical factors such as preoperative use of anticholinergics and urodynamic parameters were not predictive of postoperative improvement of OAB symptoms. Obese women were 43% less likely to experience relief from their OAB symptoms than overweight or normal-weight women. These data show that most women with stress-predominant mixed UI experience significant improvement in OAB symptoms 1 year after incontinence surgery. Although this initial improvement diminishes over time, the level of improvement at 5 years is still significant. Overactive bladder symptom improvement is blunted in obese women.