Abstract
Introduction and hypothesis
We assessed the efficacy of midurethral slings (MUS) in women with urodynamically proven mixed incontinence (UMI).
Methods
A prospective study was carried out in women with UMI in whom conservative treatment failed and who underwent MUS. Pre- and postoperative assessment included: completion of the validated ICIQ-FLUTS questionnaire, POP-Q examination and urodynamics (UDS). The primary outcome was the assessment of symptoms at 12 months. Secondary outcomes included assessment of postoperative UDS findings and evaluation of differences in symptoms and UDS diagnosis between the TVT and TVT-O groups.
Results
Eighty-five women were included; 44 (49.2%) underwent TVT and 41 (51.8%) underwent TVT-O. Concomitant prolapse surgery was performed in 65 out of 85 patients (76.5%). At 12 months’ follow-up there was a statistically significant reduction in stress urinary incontinence (p < 0.001), urge urinary incontinence (p < 0.001), urgency (p = 0.021) and frequency (p = 0.014). Depending on the symptom 10.6% to 24.7% of women reported deterioration of symptoms. UDS at 12 months revealed the absence of urodynamic stress incontinence (USI) in 82.4% of patients and no evidence of detrusor overactivity (DO) in 35.3%. No differences in symptoms were found between the TVT and TVT-O group, but the absence of DO was more common in the TVT group (48.5% vs 22.7%, p = 0.014).
Conclusions
Placement of MUS alleviates incontinence and overactive bladder symptoms in patients with UMI. TVT causes similar subjective improvement to TVT-O, but resulted in higher resolution of DO. Our study provides data that could be helpful in informing patients preoperatively of the potential impact that the MUS may have on each individual symptom separately, including the likelihood of symptom deterioration.
Similar content being viewed by others
References
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26
Sandvik H, Hunskaar S, Vanvik A, Bratt H, Seim A, Hermstad R (1995) Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiol 48:339–343
Hampel C, Wienhold D, Benken N, Eggersmann C, Thuroff JW (1997) Definition of overactive bladder and epidemiology of urinary incontinence. Urology 50 [Suppl 6A]:4–14
Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol 53:1150–1157
Dooley Y, Lowenstein L, Kenton K, Fitzgerald M, Brubaker L (2008) Mixed incontinence is more bothersome than pure incontinence subtypes. Int Urogynecol J Pelvic Floor Dysfunct 19:1359–1362
Frick AC, Huang AJ, Van Den Eeden SK, Knight SK, Creasman JM, Yang J et al (2009) Mixed urinary incontinence: greater impact on quality of life. J Urol 182:596–600
Van Leijsen SAL, Hoogstad-van Evert JS, Mol BWJ, Vierhout ME, Milani AL, Heesakkers JPFA, Kluivers KB (2011) The correlation between clinical and urodynamic diagnosis in classifying the type of urinary incontinence in women. A systematic review of the literature. Neurourol Urodyn 30:495–502
Khullar V, Cardozo L, Dmochowski R (2010) Mixed incontinence: current evidence and future perspectives. Neurourol Urodyn 29:618–622
Gomelsky Α, Dmochowski R (2011) Treatment of mixed urinary incontinence in women. Curr Opin Obstet Gynecol 23:371–375
Artibani W (2000) Difficult to manage patient populations: mixed symptomatology. BJU Int 85:53–54
Jain P, Jirschele K, Botros SM, Latthe PM (2011) Effectiveness of midurethral slings in mixed urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 22(8):923–32
Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, Sterling AM, Zinner NR, van Kerrebroeck P (2002) International Continence Society. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21(3):261–274
Abrams P, Avery K, Gardener N, Donovan J (2006) The international consultation on Incontinence Modular Questionnaire: www.iciq.net. J Urol 175(3):1063–1066
Athanasiou S, Grigoriadis T, Kyriakidou N, Giannoulis G, Antsaklis A (2012) The validation of international consultation on incontinence questionnaires in the Greek language. Neurourol Urodyn doi:10.1002/nau.22197
Ulmsten U, Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anaesthesia for treatment of female urinary incontinence. Int Urogynecol J 7:81–86
De Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730
Paick JS, Oh SJ, Kim SW, Ku JH (2008) Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct 19(1):123–129
Lee J, Dwyer P, Rosamilia A, Lim Y, Polyakov A, Stav K (2011) Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis. BJOG 118:798–805
Duckett JR, Tamilselvi A (2006) Effect of tension-free vaginal tape in women with a urodynamic diagnosis of idiopathic detrusor overactivity and stress incontinence. BJOG 113:30–33
Duckett JR, Basu M (2010) TVT vs TOT: a case controlled study in patients with mixed urodynamic stress incontinence and detrusor overactivity. Int Urogynecol J 21(7):763–766
Botros SM, Miller JJ, Goldberg RP, Gandhi S, Akl M, Beaumont JL, Sand PK (2007) Detrusor overactivity and urge urinary incontinence following transobturator versus midurethral slings. Neurourol Urodyn 26(1):42–45
Duckett JR, Basu M (2007) The predictive value of preoperative pressure flow studies in the resolution of detrusor overactivity and overactive bladder after tension free vaginal tape insertion. BJU Int 99(6):1439–42
Digesu GA, Salvatore S, Chaliha C, Athanasiou S, Milani R, Khullar V (2007) Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse? Int Urogynecol J Pelvic Floor Dysfunct 18(12):1439
Acknowledgements
Funding
None of the authors received any funding for this study
Conflicts of interest
SA and TG received travel expenses from Johnson&Johnson
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Athanasiou, S., Grigoriadis, T., Giannoulis, G. et al. Midurethral slings for women with urodynamic mixed incontinence: what to expect?. Int Urogynecol J 24, 393–399 (2013). https://doi.org/10.1007/s00192-012-1859-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-012-1859-z