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Minimally Invasive Single-Incision Sling Surgery for Stress Urinary Incontinence: Age-Related Outcomes and Predictors
Tsia-Shu Lo1, Louiza Erika Rellora2, Ai-Leen Ro3
1Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center (Drs. Lo, Rellora, Ro, Yu, Li, and Hsieh), Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center (Dr. Lo), Keelung, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei Medical Center (Dr. Lo), Taipei, Taiwan; Chang Gung University, School of Medicine (Drs. Lo and Hsieh), Taoyuan, Taiwan.
Study Objective:
To evaluate age-related outcomes of single-incision sling (SIS) procedures for stress urinary incontinence (SUI) and identify predictors of treatment failure in elderly women.
Design:
Retrospective multicenter cohort study (2015-2024).
Setting:
Three tertiary referral urogynecology centers.
Participants:
A total of 646 women with urodynamically confirmed SUI who underwent SIS using fixed-length (Ophira, Solyx) or adjustable-length (I-stop mini).
Interventions:
SIS (fixed-length and adjustable-length) placement via transvaginal approach.
Measurements And Main Results:
Patients were stratified by age: young (≤64 years), elderly (65-74 years), and old (≥75 years). Objective cure was defined as no leakage during urodynamic testing and a <2 g 1-hour pad test; subjective cure was the absence of leakage on Urogenital Distress Inventory-6 question no. 3. At 1-year follow-up, the overall objective and subjective cure rates were 89.3% and 87.0%, respectively. Cure rates declined significantly with age: objective cure rates of 93.7%, 81.1%, and 70.6%; subjective cure rates of 92.2%, 77.3%, and 64.7% (p < .001). Effectiveness decreased with increased age across sling types without significant inter-device differences. Multivariate analysis identified obesity (BMI >30 kg/2), asthma, maximal urethral closure pressure (MUCP) <40 cm H₂O, and functional urethral length <2 cm as independent risk factors for failure in elderly women. Intrinsic sphincter deficiency was the strongest predictor in both elderly and old groups.
Conclusion:
SIS is an effective minimally invasive treatment for SUI, though outcomes decline with age. Recognizing risk factors such as intrinsic sphincter deficiency, low MUCP, and short functional urethral length may optimize patient counseling and selection in older women.
