title: Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women.
abstract: OBJECTIVE
  To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline.
  
  
  METHODS
  This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data.
  
  
  RESULTS
  Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P=.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P=.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery.
  
  
  CONCLUSIONS
  Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement.
  
  
  METHODS
  II.
authors.affiliation: University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania; the University of California San Diego Health Systems, San Diego, California; Cleveland Clinic, Cleveland, Ohio; the University of Texas Southwestern, Dallas, Texas; William Beaumont Hospital, Royal Oak, Michigan; Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; the University of Utah, Salt Lake City, Utah; the University of Alabama at Birmingham, Birmingham, Alabama; and New England Research Institutes, Watertown, Massachusetts.
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski
authors.forename: Michael E
authors.initials: ME
authors.lastname: Albo
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Wai
authors.forename: Larry T
authors.initials: LT
authors.lastname: Sirls
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.forename: R E
authors.initials: RE
authors.lastname: Varner
authors.forename: Maude
authors.initials: M
authors.lastname: Carmel
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D057186:Comparative Effectiveness Research; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D057240:Patient Preference; D011183:Postoperative Complications / Q000175:diagnosis*; D011184:Postoperative Period; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods