The Effect of Midurethral Slings on Overactive Bladder Medication Use in Women with Mixed Urinary Incontinence

Mixed urinary incontinence (MUI), characterized by both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI), significantly impacts quality of life. Despite evidence suggesting that midurethral sling (MUS) procedures might improve overactive bladder (OAB) and UUI symptoms, it remains unclear whether discontinuation of OAB medications is appropriate in women with MUI undergoing MUS. We aimed to evaluate whether MUS placement changes the need for pharmacological OAB treatment postoperatively.

This retrospective cohort study included women with MUI who underwent MUS placement between 2017 and 2023 at a single academic center with at least 6 months of follow-up. Concomitant pelvic organ prolapse surgery or hysterectomy was allowed. Patients were stratified by preoperative OAB medication use. The primary outcome was postoperative OAB treatment trajectories, categorized as initiation, continuation, escalation, or discontinuation. Secondary analyses evaluated factors associated with postoperative initiation and continuation.

A total of 617 women had MUI and underwent MUS placement (mean age 59.3 ± 12.8 years; body mass index 30.2 ± 6.4 kg/m²). Most had retropubic slings (79.4%) and concomitant prolapse surgery (61.2%). Among 502 women not on OAB medications preoperatively, 74 (14.7%) initiated therapy postoperatively; these women were younger than those who did not (56.6 vs 60.2 years, p = 0.03). Among 115 women on preoperative OAB medications, 62.6% continued therapy, 12.2% required escalation, and 25.2% discontinued medication. Detrusor overactivity was more common among women initiating therapy, although this did not reach statistical significance.

Postoperative OAB treatment trajectories were heterogeneous, with most patients remaining stable, whereas a subset required initiation, escalation, or discontinuation of therapy.