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Characteristics Associated With Treatment Failure 1 Year After Midurethral Sling in Women With Mixed Urinary
Vivian W Sung1, Holly E Richter, Pamela Moalli
1Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island; the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina; the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Kaiser Permanente, Downey, California; the Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; the Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; and Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, North Carolina.
Treatment failure after midurethral sling for mixed urinary incontinence is linked to prior overactive bladder medication, detrusor overactivity, and higher first urge volume. Women with urgency may benefit from combined therapy.
Area of Science:
- Urology
- Gynecology
- Pelvic Floor Disorders
Background:
- Mixed urinary incontinence is a common condition affecting many women.
- Midurethral slings are a surgical option, but treatment failure can occur.
- Identifying factors associated with treatment failure is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate characteristics associated with treatment failure one year after midurethral sling surgery in women with mixed urinary incontinence.
- To identify predictors of treatment failure in this patient population.
Main Methods:
- Secondary analysis of a randomized trial involving 403 women with mixed urinary incontinence.
- Treatment failure defined as subjective or objective criteria met at 1-year follow-up.
- Logistic regression models used to assess predictors of treatment failure, including clinical and demographic variables.
Main Results:
- Overall treatment failure occurred in 29.6% of women.
- Previous overactive bladder (OAB) medication, detrusor overactivity, and higher volume at first urge were significantly associated with treatment failure.
- Worse Urogenital Distress Inventory (UDI) urgency scores were also linked to failure, with an interaction effect in the midurethral sling-alone group.
Conclusions:
- Specific clinical and urodynamic variables predict treatment failure following midurethral sling for mixed urinary incontinence.
- Women with more severe urgency symptoms may benefit from a combined approach of midurethral sling and perioperative behavioral/pelvic floor muscle therapy.
- The need for additional urinary treatment post-surgery was low, primarily for OAB management.
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