Midurethral sling procedures for stress urinary incontinence in women over 80 years

To compare the safety and efficacy of midurethral sling surgery for management of urinary stress incontinence in women over 80 years versus younger women.

1225 consecutive women with urodynamic stress incontinence had a synthetic midurethral sling (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Ninety one percent (n = 1112) of the patients were interviewed via phone call with a structured questionnaire and were included in the analysis. The mean follow-up was 50 ± 24 months (range 12-114). Comparison between elderly (≥80 years, n = 96) and younger patients (<80 years, n = 1016) was performed.

The overall subjective cure rate was 85% (elderly 81%, younger 85%,  = 0.32). There was no significant difference in cure rate between retropubic and transobturator sling in the elderly group (82% vs. 79.3%, P = 0.75). The bladder perforation rate was similar between the two groups (3%). The hospitalization time was significantly longer in the elderly (1.6 ± 1.7 days vs. 0.7 ± 1.1 days, P<0.001). However, major perioperative complications were uncommon (1%). Of the patients who had an isolated sling procedure, 37% of the elderly and 9% of the young patients failed their 1st trial of void (P < 0.001). However, the long-term rate of voiding difficulty was similar between the two groups (elderly 8% vs. young 6%, P = 0.21). The rate of de novo urge incontinence was similar between the two groups (7%).

Retropubic and transobturator slings in women older than 80 years are effective and safe but are associated with an increased risk of transient postoperative voiding difficulty.