title: Urgency Incontinence before and after Revision of a Synthetic Mid Urethral Sling.
abstract: OBJECTIVE
  We evaluate urgency urinary incontinence outcomes for patients who underwent revision of a presumed obstructing synthetic mid urethral sling and examine risk factors for persistent or de novo symptoms after surgery.
  
  
  METHODS
  From February 1, 2005 to June 1, 2013, 107 women underwent sling revision for new or worsening lower urinary tract symptoms after synthetic mid urethral sling surgery. Patients were grouped based on urgency urinary incontinence symptoms and characteristics associated with persistent or de novo symptoms after revision were examined using logistic regression models.
  
  
  RESULTS
  Median followup was 29 months (IQR 12-54) and time to revision was 21 months (IQR 5-48). Patients presenting for sling revision with urgency incontinence (68) were more likely to experience a more than 6-month delay to revision vs those presenting with obstructive voiding symptoms (39) (OR 3.25, 95% CI 1.33-7.92, p <0.01). After revision urgency incontinence persisted in 76.5% (52 of 68) and was associated with a pre-revision need for anticholinergic medication (OR 5.58, 95% CI 1.44-21.39, p=0.01) and smoking (OR 5.21, 95% CI 1.21-22.49, p=0.03). De novo urgency incontinence developed in 43.6% (17 of 39) of patients and was associated with de novo stress incontinence (OR 15.9, 95% CI 3.2-78.3, p <0.01). Women with post-revision urgency incontinence (de novo or persistent) had higher Urogenital Distress Inventory-6 scores than patients with no or resolution of urgency incontinence.
  
  
  CONCLUSIONS
  Patients presenting with new or worsening urgency urinary incontinence after sling placement were more likely to undergo delayed revision compared to those presenting with obstructive voiding symptoms. There is a high rate of bothersome persistent and de novo urgency incontinence after sling revision. Patient expectations should be managed accordingly before sling revision.
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Iryna M
authors.initials: IM
authors.lastname: Crescenze
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nitya
authors.initials: N
authors.lastname: Abraham
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: VASAVAS@ccf.org.
authors.forename: Sandip
authors.initials: S
authors.lastname: Vasavada
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D017211:Treatment Failure; D053202:Urinary Incontinence, Urge / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
keywords: suburethral slings; urinary bladder neck obstruction; urinary incontinence, urge