Patient related factors associated with long-term urinary continence after Burch colposuspension and pubovaginal fascial sling surgeries.
OBJECTIVE
We examined preoperative and postoperative patient related factors associated with continence status up to 7 years after surgery for stress urinary incontinence.


METHODS
Women randomized to Burch colposuspension or fascial sling surgery and assessed for the primary outcome of urinary continence 2 years after surgery were eligible to enroll in a prospective observational study. Survival analysis was used to investigate baseline and postoperative factors in the subsequent risk of stress urinary incontinence, defined as self-report of stress urinary incontinence symptoms, incontinence episodes on a 3-day diary or surgical re-treatment.


RESULTS
Of the women who participated in the randomized trial 74% (482 of 655) were enrolled in the followup study. Urinary continence rates decreased during a period of 2 to 7 years postoperatively from 42% to 13% in the Burch group and from 52% to 27% in the sling group, respectively. Among the baseline factors included in the first multivariable model age (p = 0.03), prior stress urinary incontinence surgery (p = 0.02), menopausal status (0.005), urge index (0.006), assigned surgery (p = 0.01) and recruiting site (p = 0.02) were independently associated with increased risk of incontinence. In the final multivariable model including baseline and postoperative factors, Burch surgery (p = 0.01), baseline variables of prior urinary incontinence surgery (p = 0.04), menopausal status (p = 0.03) and postoperative urge index (p <0.001) were each significantly associated with a greater risk of recurrent urinary incontinence.


CONCLUSIONS
Preoperative and postoperative urgency incontinence symptoms, Burch urethropexy, prior stress urinary incontinence surgery and menopausal status were negatively associated with long-term continence rates. More effective treatment of urgency urinary incontinence in patients who undergo stress urinary incontinence surgery may improve long-term overall continence status.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th St. South, 176 F, Suite 10382, Birmingham, Alabama 35249, USA. hrichter@uabmc.edu
Holly E
HE
Richter
Linda
L
Brubaker
Anne M
AM
Stoddard
Yan
Y
Xu
Halina M
HM
Zyczynski
Peggy
P
Norton
Larry T
LT
Sirls
Stephen R
SR
Kraus
Toby C
TC
Chai
Philippe
P
Zimmern
E Ann
EA
Gormley
John W
JW
Kusek
Michael E
ME
Albo
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D053825:Suburethral Slings; D016019:Survival Analysis; D014521:Urethra / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*