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Prognostic factors for persistent urinary incontinence after sling surgery in patients with urethral funneling
Enrique González-Díaz1, Leticia Padilla Mozo1, Ester Fraile López1
1Pelvic Floor Unit, Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), León, Spain.
Objective:
To identify preoperative prognostic factors associated with persistent urinary incontinence (UI) following mid-urethral sling (MUS) surgery in women with sonographically confirmed urethral funneling.
Design:
Retrospective cohort study.
Setting:
Tertiary referral center with a specialized urogynecology unit.
Patients:
Forty-seven women diagnosed with stress UI or stress-predominant mixed UI and urethral funneling on preoperative pelvic floor ultrasound (PFUS), undergoing MUS surgery.
Interventions:
MUS surgery performed retropubic (TVT) or transobturator (TOT) approach.
Measurements And Main Results:
Preoperative evaluation included clinical assessment, voiding diary, validated symptom questionnaires (ICIQ-UI-SF), and PFUS. Surgical success was defined as complete resolution of incontinence 24 months postoperatively. Persistent UI was observed in 27.7% of patients. On univariate analysis, higher ICIQ-UI-SF scores (p = 0.0023), longer urethral length (p = 0.011), and TOT use (p = 0.0065) were significantly associated with persistent UI. ROC curves identified ICIQ-UI-SF ≥ 18 (AUC = 0.731) and urethral length ≥ 35 mm (AUC = 0.654) as optimal cutoffs. In multivariate analysis, both ICIQ-UI-SF ≥ 18 (OR = 6.2, 95% CI: 1.2-31, p = 0.028) and TOT (OR = 6.8, 95% CI: 1.6-28.5, p = 0.009) remained independent predictors. The model showed good discrimination (AUC = 0.84).
Conclusion:
Among women with urethral funneling, greater symptom severity and the use of TOT are independently associated with persistent UI after MUS. The retropubic approach (TVT) may yield better outcomes in this high-risk population. Incorporating these predictors into preoperative decision-making may enhance surgical planning and patient counseling.
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