title: Development of de novo urge incontinence in women post sling: the role of preoperative urodynamics in assessing the risk.
abstract: OBJECTIVE
  The study was undertaken to investigate if there are specific identifiable risk factors on the preoperative history or urodynamics testing associated with an increased risk for the development of symptoms of de novo urge urinary incontinence after a minimally invasive sling procedure.
  
  
  METHODS
  Two hundred eighty-one women who had undergone minimally invasive sling surgery for stress urinary incontinence between January 2000 and December 2003 were identified. The records of 92 patients were included in this review.
  
  
  RESULTS
  Twenty-five patients (27%) reported urge urinary incontinence on postoperative questioning. Clinical and urodynamic parameters were correlated with the development of de novo urge urinary incontinence. Preoperative history parameters were not predictive of the increased risk of de novo urge urinary incontinence, with the exception of increased preoperative daytime frequency (OR 3.3 (1.2, 9.1)). Of 16 women whose detrusor pressure during the filling phase of cystometry exceeded 15 cm H(2)O, de novo urge urinary incontinence developed in 9 (56%) vs. 16 (21%) of 76 women, whose detrusor pressure was < or = 15 cm H(2)O (OR 4.6 (1.4, 15.0)).
  
  
  CONCLUSIONS
  Directed patient history is only minimally helpful in the identification of women at increased risk for the development of de novo urge urinary incontinence, with the exception of the complaint of increased daytime frequency. Women with elevated detrusor pressure during the filling phase of cystometry were more likely to develop urge urinary incontinence postoperatively. Therefore, we suggest that preoperative urodynamic evaluation, and specifically detrusor pressure > 15 cm H(2)O may help identify patients at increased risk of developing de novo urge urinary incontinence following the minimally invasive sling procedure.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh, Pennsylvania 15213, USA. malperin@mail.magee.edu
authors.forename: Marianna
authors.initials: M
authors.lastname: Alperin
authors.forename: Shafika
authors.initials: S
authors.lastname: Abrahams-Gessel
authors.forename: May M
authors.initials: MM
authors.lastname: Wakamatsu
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D019919:Prosthesis Implantation; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D053825:Suburethral Slings; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000453:epidemiology* / Q000209:etiology*; D014563:Urodynamics / Q000502:physiology*; D013520:Urologic Surgical Procedures