Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slings.
OBJECTIVE
To compare the rates of resolution of detrusor overactivity (DO) and subjective urge urinary incontinence (UUI) as well as de novo DO and UUI between the Monarc, TVT, and SPARC midurethral sling procedures.


METHODS
Two hundred and seventy-six subjects with urodynamic stress or mixed urinary incontinence underwent retropubic midurethral slings (TVT, N = 99; SPARC, N = 52) or transobturator slings (Monarc, N = 125). All evaluable subjects had a routine office evaluation, subjective assessment of UUI, and multichannel urodynamic testing pre- and 3 months postoperatively. Comparisons were made using Student's t-test, ANOVA, McNemar's test, and Chi-Square test where appropriate. Multivariate logistic regression was performed to detect possible confounding factors such as sling type, and differences in concomitant surgical procedures.


RESULTS
De novo subjective UUI differed significantly between the Monarc and the other two slings (33% TVT vs. 8% Monarc vs. 17% SPARC, P = 0.04). Fourteen to Sixteen percents of patients with preoperative UUI who underwent TVT or SPARC had worsening of their UUI symptoms while only 6% of the Monarc group did (P = 0.02). There was no difference in rates of resolution of DO among the three groups (40% vs. 48% vs. 32%, P = 0.39) or de novo DO (32% vs. 22% vs. 22%, P = 0.64) at 3 months.


CONCLUSIONS
Patients who undergo transobturator procedures have significantly lower rates of de novo UUI than those who undergo midurethral sling procedures. Rates of resolution of DO, UUI, and de novo DO do not differ between groups.
Botros
Sylvia M
SM
Evanston Continence Center, Evanston Northwestern Healthcare, Northwestern University, Feinberg School of Medicine, Evanston, Illinois, USA. smbotros@yahoo.com
Miller
Jay-James R
JJ
Goldberg
Roger P
RP
Gandhi
Sanjay
S
Akl
Mohammed
M
Beaumont
Jennifer L
JL
Sand
Peter K
PK
D015331:Cohort Studies; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000601:surgery*