Abstract
The aim of the study was to determine the rate of persistence of urgency or urge urinary incontinence following midurethral sling surgery compared to standard medication treatment in patients with mixed incontinence and ISD urethra. A prospective study was conducted at a tertiary referral Urogynecology Center. One hundred five women with stress urinary incontinence (SUI) and urgency were identified. Fifty-four consecutive women with SUI and urgency who underwent midurethral sling were compared to 51 women with SUI and urgency but treated with medications first. Women with persistent urgency or urge urinary incontinence (UUI) at 6-month follow-up following a TVT sling procedure were compared with those whose symptoms had resolved, to determine the risk factors for persistent symptoms. Forty out of 54 patients in the operation group also underwent a prolapse repair, either a colpopexy or a colpocleisis. All patients had demonstrated a mean urethral closure pressure of 20 mmHg or lower, indicating an intrinsic sphincteric deficiency. Persistent urgency (6 of 54, 11%) and UUI (3 of 54, 5.5%) were found in patients with mixed incontinence who underwent a sling operation. All 51 patients (100%) persisted with some urgency and urge incontinence despite anticholinergic medication treatment, only (7 of 51, 13.7%) reporting improvement of symptoms. Concomitant prolapse surgery, especially apical correction (OR 0.55, 95% CI 0.37–0.65), decreased the risk of urgency persistence, while age (OR 1.04, 95% CI 1.02–1.05), detrusor overactivity (OR 1.66, 95% CI 1.28–2.53), baseline symptom severity (OR 1.77, 95% CI 1.48–2.36), and previous incontinence surgery (OR 2.08, 95% CI 1.38–3.60) increased the risk of persistent urgency in the operated cohort. Women were happier in the operated cohort (45 of 54, 83.3% cure rate). A sling itself decreased the risk of persistent urge or UUI (OR 0.33, 95% CI 0.15–0.70). The most significant improvement was UUI at night. Urodynamic parameters, baseline urgency symptom severity, age, and concomitant prolapse operation are important predictors of persistent urgency or UUI following midurethral sling for mixed incontinence patients.
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