title: Worse long-term surgical outcomes in elderly patients undergoing SPARC retropubic midurethral sling placement.
abstract: OBJECTIVE
  • The purpose of our study was to evaluate long-term clinical outcomes following placement of a retropubic mid-urethral sling in patients aged 70 and over and to compare outcomes with those of a younger cohort of patients.
  
  
  METHODS
  • Patients with stress urinary incontinence undergoing retropubic polypropylene sling (SPARC(TM) ) placement were entered into a prospective, institutional review board-approved database. • Patients with at least 12 months follow-up were sent postoperative questionnaires assessing outcomes. Results of these questionnaires were compared for patients aged 70 or older and those younger than 70 years.
  
  
  RESULTS
  • A total of 337 patients who underwent SPARC sling placement in an 8-year period were identified. Of these, 290 patients had a minimum of 12 months follow-up, and among these patients, 235 (81%) answered postoperative mailed questionnaires. Average follow-up was 45.2 months. • Thirty-seven patients were 70 or older, and 198 were younger than 70. The older group had significantly lower success (53.1% vs 83.6%) and dry (6.1% vs 35.3%) rates than the younger cohort. • Assessment of preoperative variables determined that the older cohort had significantly more vaginal deliveries and a higher percentage of patients who had undergone either hysterectomy, previous prolapse and/or incontinence surgery. • There was no significant difference in Valsalva leak-point pressure, percentage of patients with intrinsic sphincteric deficiency or type 0 stress urinary incontinence between the two groups.
  
  
  CONCLUSIONS
  • Experience at our Institution shows that there are clearly lower success rates in older patients undergoing a SPARC sling as compared with a younger cohort of patients. • Parity, hysterectomy and previous pelvic organ prolapse/anti-incontinence surgery may also play a role in the difference in outcomes.
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA 98101, USA. jasonkim96@gmail.com
authors.forename: Jason
authors.initials: J
authors.lastname: Kim
authors.forename: Alvaro
authors.initials: A
authors.lastname: Lucioni
authors.forename: Fred
authors.initials: F
authors.lastname: Govier
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kobashi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010298:Parity; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011126:Polypropylenes; D053825:Suburethral Slings / Q000592:standards*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
chemical_list: D011126:Polypropylenes