title: Outcomes of Midurethral Slings in Women with Concomitant Preoperative Severe Lower Urinary Tract Voiding Symptoms.
abstract: BACKGROUND
  Women with stress urinary incontinence and concomitant obstructive (voiding) lower urinary tract symptoms (LUTS) represent a challenging patient population. Furthermore, their diagnosis and management remain incompletely studied and controversial. We evaluated the outcomes of midurethral sling procedures in women with severe obstructive LUTS.
  
  
  METHODS
  We performed a post hoc analysis of women who were part of an institutional review board-approved study of midurethral sling surgery. Preoperatively and at 4-6 weeks postoperatively, patients completed the American Urological Association Symptom Score (AUASS) questionnaire. A postvoid residual urine test was obtained preoperatively, at the time of the voiding trial, and 4-6 weeks postoperatively. Three groups of patients with severe LUTS were then defined: Group A (AUASS ≥20), Group B (voiding subscale ≥12), and Group C (urodynamic obstruction). Patients could be included in more than one group. AUASS was again obtained at a medium-term follow-up of 31.6 months.
  
  
  RESULTS
  Of 106 women completing follow-up, 30, 23, and 11 subjects met the criteria for groups A, B, and C, respectively. All had statistically significant improvements in storage and voiding subscales, as well as their stress urinary incontinence. No subject presented with retention or voiding dysfunction at follow-up. These improvements continued at medium-term follow-up with the exception of Group C that failed to demonstrate persistence of statistical improvement in AUASS subscales.
  
  
  CONCLUSIONS
  Patients with stress urinary incontinence and severe voiding LUTS can be treated safely with midurethral sling procedures. In both the short and medium term, these symptoms improve dramatically in the majority of patients.
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ingber
authors.affiliation: Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Krlin
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Farzeen
authors.initials: F
authors.lastname: Firoozi
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
keywords: Lower urinary tract symptoms; suburethral slings; urinary incontinence–stress