Functional outcomes of mid-urethral tapes in female neurogenic stress and mixed urinary incontinence: A single centre experience

Abstract

Study design:Retrospective Objectives:To evaluate the mid-term urodynamic and clinical efficacy of mid-urethral synthetic sling (MUS) in females with neurogenic stress urinary incontinence (N-SUI) or neurogenic mixed urinary incontinence (N-MUI). Materials and methods:Between January and April 2021, we conducted a retrospective review of all adult neurological women with clinically and urodynamically proven N-SUI or N-MUI who were treated with retropubic (TVT) or transobturator (TOT) tension free vaginal tape. The outcomes were recorded in a database over a 14-year period.The primary objective outcome measure was the absence of any N-SUI episodes at 3 days Bladder Diary (BD). A Patient Global Impression of Improvement (PGI-I) score ≤ 2 was a secondary endpoint for subjective success. Objective failure was defined as the detection of stress urinary incontinence during follow-up urodynamics. Results:Twenty-three women out of 65 were included. Mean follow-up was 72.2 ± 45.6 months. TVT was placed in 17/23 patients (74%) who were previously managed by intermittent catheters (IC) and TOT in those 6/23 women (26%) who spontaneously voided at baseline.Dryness at 3 days BD was observed in 12/23 patients (52%). Twenty patients (86%) reported subjective benefits (mean PGI-I 1.4 ± 0.62), of whom eleven (55%) were extremely satisfied (PGI-I = 1).Objective failure was documented in 2/23 women (8%) after surgery. Two patients shifted from IC to indwelling catheter during follow-up (respectively 6 and 8 years after surgery). De novo neurogenic detrusor overactivity was observed in two women at 3 months follow-up. No statistical differences were observed in cystometric parameters comparing baseline to follow-up. Conclusion:To the best of our knowledge, this is the first study confirming the clinical efficacy and urodynamic safety over a 5-year follow-up, for N-MUI as well. According to our results both TOT and TVT can be used to treat women with N-SUI with or without concomitant NDO. The choice between the two procedures depended on baseline bladder management.