Goal Achievement in Women With Urinary Incontinence After Midurethral Sling

Treatment goals are understudied among women undergoing midurethral sling (MUS) surgery for mixed urinary incontinence (MUI).

The objectives of this study were to describe treatment goals in participants with MUI undergoing MUS with or without perioperative behavioral and physical therapy (BPT). Secondary objectives included describing goal achievement and identifying predictors of achievement.

Participants in a multicenter, randomized trial of MUS surgery with or without BPT completed patient-reported outcome (PRO) measures and the Self-Assessment Goal Achievement questionnaire (rating the importance of 9 preset goals on a 6-point scale, self-identifying 5 additional goals). At baseline, 6 months and 12 months, goal achievement was rated on a 5-point scale with 5 indicating "greatly exceeded goal" and scores ≥4 considered "achieved." Self-identified goal themes were identified, and factors associated with goal achievement were examined.

Mean age of the 366 participants was 54.6 (10.4) years, 348 (95.0%) rated stress urinary incontinence-related goals 5/5 in importance, and 319 (87.2%) rated ≥1 of the urgency-related goals 5/5 in importance. Goal themes included coping, hygiene, effect on activities, sexual function, social function, and self-esteem. Achievement of at least 1 goal occurred in 346 of 366 (94.5%) with no differences between groups for most goals by 12 months. Compared with the MUS alone group, the MUS with or without BPT group had higher odds of achieving ≥1 urgency-related preset goal at 6 months (adjusted odds ratio, 2.90; 95% CI, 1.59-5.30, P<0.001). Goal achievement was associated with greater improvements in PROs.

Among women with MUI undergoing MUS surgery with or without BPT, the majority reported high importance of both stress and urgency-related goals. Most stress- and urgency-related goals were achieved by 12 months.