Detrusor underactivity and complicated stress urinary incontinence: a cross-data study

Area of Science:

• Urology
• Female Pelvic Medicine
• Reconstructive Surgery

Background:

• Detrusor underactivity (DUA) is a condition affecting bladder function, and its impact on surgical outcomes for stress urinary incontinence (SUI) remains unclear.
• Evidence regarding DUA in complicated stress urinary incontinence (C-SUI) is particularly limited.

Purpose of the Study:

• To evaluate the outcomes of middle urethral sling (MUS) placement in women with SUI.
• To assess the influence of DUA on both uncomplicated SUI (U-SUI) and C-SUI, considering functional and surgical results.

Main Methods:

• A study involving patients undergoing MUS surgery, categorized into four groups based on SUI type (U-SUI vs. C-SUI) and DUA presence.
• DUA diagnosis based on established clinical criteria.
• Post-operative assessment of functional outcomes, including Pelvic Organ Urinary Retention (POUR) rate, de novo overactive bladder (OAB) syndrome, and SUI recurrence.

Main Results:

• Out of 97 women completing 2-year follow-up, 54.6% had DUA.
• Post-operative International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms (ICIQ-FLUTS) scores improved more in women without DUA.
• Post-operative Qmax was significantly higher in the no-DUA group.
• POUR rates, de novo OAB, tape incision, and SUI recurrence rates showed no significant differences between DUA and no-DUA groups for both C-SUI and U-SUI.

Conclusions:

• Pre-operative DUA has a minimal impact on the outcomes of MUS surgery, even in cases of C-SUI.
• Women with SUI, including those with complicated cases and DUA, should not be excluded from considering MUS surgery.