Association of Empty Cough Stress Test with Midurethral Sling Outcomes and Intrinsic Sphincter Deficiency in Women with Stress Urinary Incontinence.

Introduction and hypothesis: The evaluation of surgical outcomes for mid-urethral sling (MUS) procedures in treating stress urinary incontinence (SUI) is critical for optimizing patient care. This study is aimed at evaluating the association between empty cough stress test (CST) results and surgical outcomes in MUS procedures, and its role in detecting intrinsic sphincter deficiency (ISD).

Methods: This was a retrospective cohort study of women who underwent MUS procedures at a single academic center between 2017 and 2023. Patient information including demographics, perioperative factors, urodynamic parameters, and postoperative outcomes were extracted from electronic medical records.

Results: A total of 1215 women underwent MUS procedures, with 347 (28.6%) testing positive on the empty CST. The median follow-up period was 12 months (range 8 to 16). Empty CST-positive women were younger (median age 53 vs 57 years, p < 0.001) and more likely premenopausal. No significant differences were observed between the groups in SUI recurrence after MUS procedures (3.2% vs 4.8%, p = 0.477) or in reoperation rates for persistent SUI. The empty CST showed high specificity for leak point pressure ≤ 60 cm H₂0 (86.5%) and low maximum urethral closure pressure ≤ 20 cm H₂0 (85.3%), but limited sensitivity (17.7% and 3.7% respectively). CST positivity was initially associated with lower point Aa values (55.3% vs 74.0%, p < 0.001), but this lost significance after adjustment for confounders.

Conclusions: Empty CST is not predictive of MUS success outcomes and shows high specificity with low sensitivity for detecting ISD, making it a useful yet limited diagnostic tool.