Prognostic factors for persistent urinary incontinence after sling surgery in patients with urethral funneling

IF 2.3 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2026-03-25 Epub Date: 2026-02-08 DOI:10.1016/j.ejogrb.2026.115000

Enrique González-Díaz, Leticia Padilla Mozo, Ester Fraile López, Camino Fernández Fernández

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引用次数: 0

Abstract

Objective

To identify preoperative prognostic factors associated with persistent urinary incontinence (UI) following mid-urethral sling (MUS) surgery in women with sonographically confirmed urethral funneling.

Design

Retrospective cohort study.

Setting

Tertiary referral center with a specialized urogynecology unit.

Patients

Forty-seven women diagnosed with stress UI or stress-predominant mixed UI and urethral funneling on preoperative pelvic floor ultrasound (PFUS), undergoing MUS surgery.

Interventions

MUS surgery performed retropubic (TVT) or transobturator (TOT) approach.

Measurements and main results

Preoperative evaluation included clinical assessment, voiding diary, validated symptom questionnaires (ICIQ-UI-SF), and PFUS. Surgical success was defined as complete resolution of incontinence 24 months postoperatively. Persistent UI was observed in 27.7% of patients. On univariate analysis, higher ICIQ-UI-SF scores (p = 0.0023), longer urethral length (p = 0.011), and TOT use (p = 0.0065) were significantly associated with persistent UI. ROC curves identified ICIQ-UI-SF ≥ 18 (AUC = 0.731) and urethral length ≥ 35 mm (AUC = 0.654) as optimal cutoffs. In multivariate analysis, both ICIQ-UI-SF ≥ 18 (OR = 6.2, 95% CI: 1.2–31, p = 0.028) and TOT (OR = 6.8, 95% CI: 1.6–28.5, p = 0.009) remained independent predictors. The model showed good discrimination (AUC = 0.84).

Conclusion

Among women with urethral funneling, greater symptom severity and the use of TOT are independently associated with persistent UI after MUS. The retropubic approach (TVT) may yield better outcomes in this high-risk population. Incorporating these predictors into preoperative decision-making may enhance surgical planning and patient counseling.

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尿道漏斗患者吊带术后持续性尿失禁的预后因素分析

目的探讨超声检查证实有尿道漏斗的女性中尿道悬吊术后持续性尿失禁（UI）的术前预后因素。设计回顾性队列研究。三级转诊中心，设有泌尿妇科专科。术前盆底超声（PFUS）诊断为应激性尿失禁或应激性混合性尿失禁和尿道漏斗的47例女性接受了MUS手术。介入：us手术采用耻骨后（TVT）或经闭（TOT）入路。测量方法及主要结果术前评价包括临床评价、排尿日记、有效症状问卷（ICIQ-UI-SF）、PFUS。手术成功定义为术后24 个月尿失禁的完全解决。27.7%的患者出现持续性尿失禁。在单变量分析中，较高的ICIQ-UI-SF评分（p = 0.0023）、较长的尿道长度（p = 0.011）和TOT使用（p = 0.0065）与持续性尿失禁显著相关。ROC曲线确定ICIQ-UI-SF ≥ 18 （AUC = 0.731）和尿道长度 ≥ 35 mm （AUC = 0.654）为最佳截断点。在多变量分析中，ICIQ-UI-SF ≥ 18 （OR = 6.2, 95% CI: 1.2-31, p = 0.028）和TOT （OR = 6.8, 95% CI: 1.6-28.5, p = 0.009）仍然是独立的预测因子。该模型具有良好的判别性（AUC = 0.84）。结论尿道漏斗型女性术后持续尿失禁与症状严重程度和使用TOT独立相关。耻骨后入路（TVT）可能在这种高危人群中产生更好的结果。将这些预测因素纳入术前决策可以提高手术计划和患者咨询。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.