Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis.

ABSTRACT

OBJECTIVE: To determine risk factors for persistence of urgency or urge urinary incontinence following midurethral sling surgery. DESIGN: Prospective cohort study. SETTING: Tertiary referral Urogynaecology Unit. SAMPLE A total of 754 consecutive women with stress urinary incontinence (SUI) and urgency; and 514 women with SUI and urge urinary incontinence (UUI) who underwent midurethral sling with a mean follow up of 50 months. METHODS: Women with persistent urgency or UUI at long-term follow up were compared with those whose symptoms had resolved, using multivariate analysis to determine the risk factors for persistent symptoms. MAIN OUTCOMES MEASURES: Odd ratios (OR) of independent risk factors for persistent urgency or UUI. RESULTS: Persistent urgency (304/754, 40%) and UUI (166/514, 32%) were common. Coexistent detrusor overactivity (OR 2.04, 95% CI 1.39-3.01), baseline symptom severity (OR 1.41, 95% CI 1.10-1.78) and age (OR 1.03, 95% CI 1.02-1.04) increased the risk of persistent urgency, while transobturator sling surgery (OR 0.61, 95% CI 0.39-094) and concomitant prolapse surgery (OR 0.54, 95% CI 0.38-0.75) decreased the risk. For UUI detrusor overactivity (OR 1.86, 95% CI 1.18-2.93), baseline symptom severity (OR 1.88, 95% CI 1.38-2.56), previous incontinence surgery (OR 2.18, 95% CI 1.28-3.70) increased the risk of persistence, whereas apical prolapse surgery (OR 0.33, 95% CI 0.15-0.70) decreased the risk. Women were more likely not to recommend surgery when they experienced persistent urgency (15.8% versus 2.7%, P < 0.0001) or UUI (24.7% versus 2.9%, P < 0.0001). CONCLUSIONS: Urodynamic parameters, baseline urgency symptom severity, midurethral sling route and concomitant prolapse operation are important predictors of persistent urgency or UUI following midurethral sling.