Durability of Retropubic Suburethral Sling Procedure and Predictors for Successful Treatment Outcome in Women With Stress Urinary Incontinence

Abstract

ObjectiveTo investigate the long-term durability of retropubic suburethral sling procedure for female stress urinary incontinence (SUI) and to identify urodynamic factors that might predict long-term successful outcomes. Materials and MethodsIn total, 286 women who underwent a retropubic suburethral sling for SUI were enrolled in this retrospective survey. Most patients received uroflowmetry, postvoid residual volume study and standardized video urodynamic testing preoperatively and 6 months postoperatively in half of them. Surgical results, demographic characteristics, preoperative and postoperative urodynamic parameters, and postoperative clinical manifestation were retrospectively analyzed. Urodynamic parameters that predict a failure outcome were investigated. ResultsThe median follow-up period was 10 years (4-29 years). The overall subjective cure rate was 80.8%. The success rates of the sling procedures at 3, 5, 10, 15, and 20 years were 89.2%, 87.7%, 78.8%, 68.6%, and 60.0%, respectively. Vaginal delivery and greater parity had negative influence on cure rate (P = .004 and .013, respectively). A significant interaction was detected from the baseline to 6 months between successes and failures for maximum flow rate (Qmax) (P = .007), voided volume (P = .020), and bladder outlet obstruction index (P = .001). Univariate analysis revealed significant decrease of Qmax, volume, and voiding efficiency; and increase of postvoid residual volume, detrusor pressure, and bladder outlet obstruction index in patients with successful outcome. However, multivariate logistic regression failed to find predictive factors for a failure suburethral sling procedure. ConclusionRetropubic suburethral sling has a durable long-term effect for SUI. Slightly increased bladder outlet resistance after retropubic suburethral sling might be helpful for achieving long-term dryness.