MP33-08 RESOLUTION OF URGENCY URINARY INCONTINENCE AFTER INCISION OF AN OBSTRUCTING SYNTHETIC SLING

Abstract

INTRODUCTION AND OBJECTIVES: Women with iatrogenic obstruction after synthetic sling placement often present with de novo or worsening urgency, frequency, and urgency urinary incontinence (UUI). The objective of this study was to determine the optimal time for sling incision to achieve resolution of urgency urinary incontinence. METHODS: 72 women who had a synthetic mid-urethral sling placed, developed de-novo or worsening urgency urinary incontinence, and then underwent sling incision for obstruction, were included in the study. On follow-up, women were administered UDI-6 and satisfaction questionnaires. ROC analysis was utilized to determine a statistically significant time point for sling incision with regard to resolution of urgency urinary incontinence. This cut-off was used to create early and delayed incision groups, which were compared using Wilcoxon rank-sum test for continuous variables and chi-square test for categorical variables. Multivariable logistic regression analysis was used to evaluate the association between early vs. delayed sling incision surgery and resolution of UUI and persistence of UUI while adjusting for age, BMI, diabetes, smoking status, vaginal parity, and sling approach. RESULTS: Median age was 55 (95%CI 51-59). Median number of months of follow-up after sling incision was 22 (95%CI 15-31). Median number of months from sling placement to sling incision was 25 (95%CI 16-32). ROC analysis revealed statistical significance using a cutpoint for resolution of UUI at 24 months. Rate of resolution of UUI was lower in the delayed incision group. UUI was more severe in the delayed incision group. See Table. Multivariable regression analysis revealed that women who underwent delayed incision were more likely to have persistent urgency urinary incontinence compared to women who underwent early incision (OR 2.13, 95% CI 0.42-10.8), though this was not statistically significant. CONCLUSIONS: Delayed sling incision results in lower rates of resolution of UUI. Women with de-novo or worsening UUI, presumably related to iatrogenic obstruction, should undergo sling incision sooner, rather than later. Women considering sling incision beyond 24 months should be counseled regarding lower rates of UUI resolution.