Effect of Lower Urinary Tract Condition on Surgical Outcomes of Different Suburethral Sling Procedures for Female Stress Urinary Incontinence.

Abstract

Purpose: Stress urinary incontinence (SUI) annoyed women worldwide and surgery remain importance for those who failed to observative managements.

Methods: We retrospectively reviewed medical records of 533 female patients with mixed urinary incontinence and predominant SUI in a medical center. Some patients may have had stage 3 or higher cystocele and underwent concomitant anterior colporrhaphy. Patients were divided into four groups: pubovaginal sling (PVS) alone, PVS with colporrhaphy, transobturator suburethral sling (TOT) alone and TOT with colporrhaphy. The primary outcome was the long-term cumulative success rate in different groups and a successful outcome defined as dry or less than one pad usage per day. The secondary outcomes were subjective postoperative lower urinary tract symptoms and various perioperative complications.

Results: The long-term cumulative success rate of PVS group with or without colporrhaphy are significantly higher than those in TOT group with or without colporrhaphy (p< 0.001). The group of PVS with concurrent colporrhaphy obtained highest success rate, followed by the PVS alone, TOT with colporrhaphy and TOT alone (p=0.003). Furthermore, the highest rate of persistent overactive bladder was noted in TOT alone group (p< 0.001).

Conclusions: This study suggests PVS is superior to TOT in terms of incontinent symptom control and long-term success rate. Concurrent colporrhaphy may be also helpful for anti-incontinent effect.