Does the diagnosis of detrusor overactivity affect the long-term prognosis of patients treated with a retropubic midurethral sling?
OBJECTIVE
There are few long-term studies on the midurethral sling (MUS) procedure in patients with preoperative detrusor overactivity (DO) and there is debate regarding the usefulness of preoperative cystometry. This study was designed to provide long-term efficacy and safety data for the Advantage MUS and to compare the outcomes in patients with pure urodynamic stress incontinence (USI) with the outcomes in patients with mixed USI and DO.


METHODS
This was a retrospective consecutive case series study of 100 patients with USI (USI-only group) matched to a consecutive group of a further 100 patients with preoperative USI and DO (mixed group) treated with a retropubic MUS. Outcomes were assessed using the King's Health Questionnaire and Patient Global Impression of Improvement questionnaire.


RESULTS
After a mean follow up of 6 years more patients in the USI-only group described themselves as "very much better" or "much better" (86 % USI-only group vs. 57 % mixed group; p = 0.007). Quality of life was improved at 6 years from baseline in both groups. Patients in the mixed group were more likely to complain of urgency (69 % vs. 42 %; p = 0.0007) which was more likely to be severe (34 % vs. 10 %; p = 0.004). A repeat MUS procedure was needed in 1 % of patients and 0.6 % needed surgical removal of the MUS for persistent troublesome pain.


CONCLUSIONS
This study suggests that the preoperative diagnosis of DO affects the long-term patient-perceived outcome of the MUS procedure. However, most patients have significant long-term improvement in quality of life.
Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, ME7 5NY, UK.
Aswini
A
Balachandran
Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, ME7 5NY, UK. jraduckett@hotmail.com.
Jonathan
J
Duckett
D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000706:statistics & numerical data*; D053201:Urinary Bladder, Overactive / Q000150:complications*; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
Detrusor overactivity; Midurethral sling; Overactive bladder; Urodynamic stress incontinence