Risk factors associated with urge incontinence after continence surgery

We identified preoperative factors associated with bothersome urge urinary incontinence after incontinence surgery (Burch or sling).

Postoperative urge urinary incontinence was defined as treatment for urge urinary incontinence 6 or more weeks after surgery. Variables thought to affect postoperative urge urinary incontinence included age, race, prior incontinence surgery or treatment, body mass index, pelvic organ prolapse quantification stage, frequency of stress and urge symptoms, incontinence episode frequency, concomitant surgery and urodynamic findings. Bivariate logistic regression models were fit in which each covariate was controlled for separately to ascertain potential importance. After controlling for surgery several baseline factors were associated with postoperative urge urinary incontinence (p <0.10) and used in multivariable modeling, including age, body mass index, prior incontinence surgery, prior anticholinergic medication, stress and urge symptom scores, detrusor overactivity and detrusor pressure at maximum flow.

Of 655 women who had surgical re-treatment for stress urinary incontinence 34 were excluded from study. Participants had a mean +/- SD age of 51 +/- 10 years. Stress and urge symptom scores were 19.3 +/- 4.6 and 6.4 +/- 3.9, respectively. Of the women 89 (14%) had prior incontinence surgery and 165 (27%) had taken anticholinergic medication. A total of 132 women (21%) required treatment for postoperative urge urinary incontinence (50 Burch, 82 sling). Odds of treatment for urge urinary incontinence after surgery were significantly higher after sling compared to Burch (OR 1.72, 95% CI 1.16-2.54, p = 0.007). A 10-point increase in preoperative Medical, Epidemiologic, and Social Aspects of Aging urge score, prior anticholinergic use and detrusor overactivity all independently increased the odds of urge urinary incontinence.

Women are almost twice as likely to need treatment for postoperative urge urinary incontinence after sling than Burch. Women with preoperative urge, detrusor overactivity or prior use of anticholinergic medications are more likely to have bothersome urge urinary incontinence postoperatively.