Midurethral slings for women with urodynamic mixed incontinence: what to expect?
OBJECTIVE
We assessed the efficacy of midurethral slings (MUS) in women with urodynamically proven mixed incontinence (UMI).


METHODS
A prospective study was carried out in women with UMI in whom conservative treatment failed and who underwent MUS. Pre- and postoperative assessment included: completion of the validated ICIQ-FLUTS questionnaire, POP-Q examination and urodynamics (UDS). The primary outcome was the assessment of symptoms at 12 months. Secondary outcomes included assessment of postoperative UDS findings and evaluation of differences in symptoms and UDS diagnosis between the TVT and TVT-O groups.


RESULTS
Eighty-five women were included; 44 (49.2%) underwent TVT and 41 (51.8%) underwent TVT-O. Concomitant prolapse surgery was performed in 65 out of 85 patients (76.5%). At 12 months' follow-up there was a statistically significant reduction in stress urinary incontinence (p < 0.001), urge urinary incontinence (p < 0.001), urgency (p = 0.021) and frequency (p = 0.014). Depending on the symptom 10.6% to 24.7% of women reported deterioration of symptoms. UDS at 12 months revealed the absence of urodynamic stress incontinence (USI) in 82.4% of patients and no evidence of detrusor overactivity (DO) in 35.3%. No differences in symptoms were found between the TVT and TVT-O group, but the absence of DO was more common in the TVT group (48.5% vs 22.7%, p = 0.014).


CONCLUSIONS
Placement of MUS alleviates incontinence and overactive bladder symptoms in patients with UMI. TVT causes similar subjective improvement to TVT-O, but resulted in higher resolution of DO. Our study provides data that could be helpful in informing patients preoperatively of the potential impact that the MUS may have on each individual symptom separately, including the likelihood of symptom deterioration.
First Department of Obstetrics & Gynecology, Urogynecology Unit, University of Athens, 98A Vas. Sofias Avenue, 11528 Athens, Greece. stavros.athanasiou@gmail.com
Stavros
S
Athanasiou
Themos
T
Grigoriadis
George
G
Giannoulis
Athanasios
A
Protopapas
Aris
A
Antsaklis
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology*