Predictors of persistent detrusor overactivity after transvaginal sling procedures.
OBJECTIVE
Determine predictors of persistent postoperative detrusor overactivity and urge urinary incontinence after sling procedures for stress urinary incontinence


METHODS
Three hundred five women with mixed urinary incontinence underwent sling procedures for stress urinary incontinence. Risk factors for persistent detrusor overactivity and urge urinary incontinence were examined using logistic regression models.


RESULTS
Women (31.5%) who had postoperative resolution of detrusor overactivity. Transobturator slings had the lowest rate of persistent detrusor overactivity (53%), followed by retropubic (SPARC = 66%; TVT = 64%) and bladder neck slings (86%). Predictors for persistent detrusor overactivity included age (odds ratio [OR], 1.38; P = .001), prior hysterectomy (OR, 1.95; P = .012), paravaginal repair (OR, 0.46; P = .015), nocturia (OR, 1.91; P = .013), maximum cystometric capacity (OR, 0.79; P < .001), detrusor overactivity volume (OR, 0.83; P = .006), urethral closure pressure (OR, 0.83; P < .001), and maximum urinary flow rate (OR, 0.77; P = .014). Persistent urge urinary incontinence was predicted by sling type (P < .001).


CONCLUSIONS
When treating women with mixed urinary incontinence, age, nocturia, maximum cystometric capacity, and choice of sling procedure impact persistence of detrusor overactivity and urge urinary incontinence.
Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Tondalaya L
TL
Gamble
Sylvia M
SM
Botros
Jennifer L
JL
Beaumont
Roger P
RP
Goldberg
Jay-James R
JJ
Miller
Oyinlolu
O
Adeyanju
Peter K
PK
Sand
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D053825:Suburethral Slings; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics; D014596:Uterine Prolapse / Q000175:diagnosis / Q000601:surgery*