title: Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence?
abstract: OBJECTIVE
  Midurethral sling (MUS) can improve overactive bladder (OAB) symptoms. It is unclear if anterior/apical prolapse (AA) repair provides additional benefit. We hypothesized that women with mixed urinary incontinence (MUI) experience greater improvement in the OAB component of their symptoms after concomitant MUS and AA repair compared with MUS alone.
  
  
  METHODS
  This is a retrospective cohort study of women with bothersome MUI (defined by objective stress test and validated questionnaire) undergoing MUS alone ("MUS-only") or concomitant MUS and AA repair ("MUS + AA"). Our primary outcome was the Overactive Bladder Questionnaire Symptom Severity (OAB-q SS) change score 6 weeks after surgery.
  
  
  RESULTS
  Of 151 women, 67 (44 %) underwent MUS-only and 84 (56 %) underwent MUS + AA. The MUS-only cohort was younger and had less severe baseline prolapse (p < 0.05 for both). Postoperative complications (predominantly UTI) occurred in 35 (23 %) patients and were similar between cohorts. For all subjects mean OAB-q SS scores significantly improved postoperatively (p < 0.05). Our primary outcome, OAB-q SS change score, showed no significant differences between cohorts (30 ± 26 MUS-only vs 25 ± 25 MUS + AA, p = 0.20), indicating similar improvements in OAB symptoms. Multivariate linear regression analysis revealed no difference in OAB-q SS change score between cohorts; however, OAB-q SS change scores were lower for women with a postoperative complication (β = -19, 95 % CI -31 to -6; p < 0.01).
  
  
  CONCLUSIONS
  In women with bothersome MUI, concomitant AA repair does not result in additional improvement in OAB symptoms over MUS alone. Patients with postoperative complications exhibit less improvement in OAB symptoms.
authors.affiliation: Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Drive Suite 310, Durham, NC, 27707, USA, alexis.dieter@duke.edu.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Dieter
authors.forename: Autumn L
authors.initials: AL
authors.lastname: Edenfield
authors.forename: Alison C
authors.initials: AC
authors.lastname: Weidner
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Levin
authors.forename: Nazema Y
authors.initials: NY
authors.lastname: Siddiqui
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*