Skip to main content

Advertisement

SpringerLink
Log in

Outcomes and failure risks in mid-urethral sling insertion in elderly and old age with urodynamic stress incontinence

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

To study the surgical outcomes and risk factors for failure of three types of mid urethral slings(MUS) surgeries in elderly and old age women with urodynamic stress incontinence(USI).

Methods

Three different types of MUS surgeries [single incision sling(SIS), trans-obturator tape(TOT), retro-public mid-urethral sling-tension-free vagina tape (TVT)]were performed among three age groups of women (young <64 yr, elderly 65-74 yr and old >75 yr) with USI. They were followed up for 1 year.

Results

Complete postoperative data was available for 688 women. After 1 year, overall objective cure rate was 88.2% and subjective cure rate was 85.9%. Among the young, elderly, and old age women objective cure rates were 91.0%, 80.6%, 66.7% and subjective cure rates were 89.2%, 77.6%, 58.3% respectively. Urodynamic parameters demonstrated flow rate, higher post-void bladder residual, smaller cystometric capacity, and lower maximum urethral closure pressure were significantly lower among old and elderly group. Subjectively, urinary distress inventory-6 (UDI-6) and incontinence impact questionnaire-7(IIQ-7) improved significantly in all groups with significant changes from baseline only in older women. Intrinsic sphincter deficiency(ISD) was found to be significantly associated with failure in older women. Other preoperative comorbidities were equally distributed among all the three age groups. The operative time, perioperative complications, and length of hospital stay showed no difference between the study groups.

Conclusions

MUS surgery is safe for the young and aging patients with USI and demostrated significant improvement in its outcomes, but objective and subjective cure rates decreases with age. ISD was also found to be significantly associated with failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Abbreviations

MUS:

Mid-urethral sling

SIS:

Single incision sling

TOT:

Trans-obturator tape

MUS-r:

Retro-public mid-urethral sling

TVT:

Tension-free vaginal tape

SUI:

Stress urinary incontinence

DO:

Detrusor overactivity

BOO:

Bladder outlet obstruction

LUTS:

Lower urinary tract symptoms

UDS:

Urodynamic studies

USI:

Urodynamic stress incontinence

ISD:

Intrinsic sphincter deficiency

Qmax:

Maximum flow rate

Dmax:

Detrusor pressure at maximum flow

PVR:

Post-void residual

MUCP:

Maximum urethral closure pressure

FUL:

Functional urethral length

CC:

Cystometric capacity

CST:

Cough stress test

POP-Q:

Pelvic organ prolapse-quantification

UDI-6:

Urinary distress inventory-6

IIQ-7:

Incontinence impact questionnaire-7

References

  1. Herzog AR, Fultz NH. Prevalence and incidence of urinary incontinence in community-dwelling populations. J Am Geriatr Soc. 1990;38:273–81.

    Article  CAS  Google Scholar 

  2. Homma Y, Imajo C, Takahashi S, Kawabe K, Aso Y. Urinary symptoms and urodynamics in a normal elderly population. Scand J Urol Nephrol Suppl. 1994;157:27–30.

    CAS  PubMed  Google Scholar 

  3. Hald T, Horn T. The human urinary bladder in ageing. Br J Urol. 1998;82(Suppl 1):59–64.

    Article  Google Scholar 

  4. Nuotio M, Jylha M, Luukkaala T, et al. Urgency, urge incontinence and voiding symptoms in men and women aged 70 years and over. BJU Int. 2002;89:350–5.

    Article  CAS  Google Scholar 

  5. Diokno AC, Brown MB, Brock BM, et al. Clinical and cystometric characteristics of continent and incontinent noninstitutionalized elderly. J Urol. 1988;140:567–71.

    Article  CAS  Google Scholar 

  6. Amundsen CL, Parsons M, Tissot B, Cardozo L, Diokno A, Coats AC. Bladder diary measurements in asymptomatic females: functional bladder capacity, frequency, and 24-hr volume. Neurourol Urodyn. 2007;26:341–9.

    Article  Google Scholar 

  7. Shin YS, On JW, Kim MK. Effect of aging on urodynamic parameters in women with stress urinary incontinence. Korean J Urol. 2015;56:393–7.

    Article  Google Scholar 

  8. Chai TC, Huang L, Kenton K, Richter HE, Baker J, Kraus S, et al. Urinary incontinence treatment network (UITN). Association of baseline urodynamic measures of urethral function with clinical, demographic, and other urodynamic variables in women prior to undergoing midurethral sling surgery. Neurourol Urodyn. 2012;31:496–501.

  9. Zizza CA, Ellison KJ, Wernette CM. Total water intakes of community-living middle-old and oldest-old adults. J Gerontol A Biol Sci Med Sci. 2009;64:481–6.

    Article  Google Scholar 

  10. Lo TS, Wang AC, Horng SG, Liang CC, Soong YK. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand. 2001;80:65–70.

    Article  CAS  Google Scholar 

  11. Lo TS, Jaili SB, Tan YL, Wu PY. A 5-year follow-up study on Monarc transobturator tape for surgical treatment of primary stress urinary incontinence. Int Urogynecol J. 2016;27:1653–9.

    Article  Google Scholar 

  12. Lo TS, Chua S, Kao CC, Uy-Patrimonio MC, Ibrahim R, Tan YL. Five-year outcome of MiniArc single-incision sling used in the treatment of primary urodynamic stress incontinence. J Minim Invasive Gynecol. 2018;25:116–2.

    Article  Google Scholar 

  13. Haylen BT, de Ridder D, Freeman RM, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.

    Article  Google Scholar 

  14. Lo TS, Shailaja N, Chua S, Tseng LH, Kao CC, Wu MP. Evaluation of clinical outcome and risk factors for failure of single-incision midurethral short tape procedure (Solyx tape) for stress urinary incontinence. J Minim Invasive Gynecol. 2018. https://doi.org/10.1016/j.jmig.2018.07.013.

  15. Blaivas J, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19:553e64.

    Google Scholar 

  16. Uebersax J, Wyman J, Shumaker S, McClish D, Fantl J. Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Neurourol Urodyn. 1995;14:131e9.

    Article  Google Scholar 

  17. Shumaker S, Wyman J, Uebersax J, McClish D, Fantl J. Health related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Qual Life Res. 1994;45:291e306.

    Google Scholar 

  18. Malek JM, Ellington DR, Jauk V, Szychowski JM, Parden AM, Richter HE. The effect of age on stress and urgency urinary incontinence outcomes in women undergoing primary midurethral sling. Int Urogynecol J. 2015;26:831–5.

    Article  Google Scholar 

  19. Alas A, Chinthakana O, Espaillat L, Plowright L, Aguilar V, Davila GW. Are suburethral slings less successful in the elderly? Int Urogynecol J. 2017;28(4):553–9.

    Article  Google Scholar 

  20. Engen M, Svenningsen R, Schiøtz HA, Kulseng-Hanssen S. Mid-urethral slings in young, middle-aged, and older women. Neurourol Urodyn. 2018;37:2578–85.

    Article  Google Scholar 

  21. Laterza RM, Halpern K, Ulrich D, Graf A, Tamussino K, Umek W. Austrian TVT vs. TVT-O study group. Influence of age, BMI and parity on the success rate of midurethral slings for stress urinary incontinence. PLoS One. 2018;13:e0201167.

    Article  Google Scholar 

  22. Tan YL, Lo TS, Khanuengkitkong S, Dass AK. Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women. Taiwan J Obstet Gynecol. 2014;53:348–54.

    Article  Google Scholar 

  23. Kim J, Lucioni A, Govier F, Kobashi K. Worse long-term surgical outcomes in elderly patients undergoing SPARC retropubic midurethral sling placement. BJU Int. 2011;108(5):708–12.

    PubMed  Google Scholar 

  24. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311e6.

    Article  Google Scholar 

  25. Pfisterer MH, Griffiths DJ, Schaefer W, Resnick NM. The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc. 2006;54(3):405–12.

    Article  Google Scholar 

  26. Petros P, Ulmsten U. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol. 1993;153:1–93.

    CAS  Google Scholar 

  27. Lo TS, Tan YL, Wu PY, Cortes EFM, Pue LB, Al-kharabsheh AM. Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). Eur J Obstet Gynecol Reprod Biol. 2014;182:91–7.

    Article  Google Scholar 

  28. Lo TS, Huang HJ, Chang CL, Wong SY, Horng SG, Liang CC. The use of intravenous anesthesia for tension free vaginal tape therapy in elderly women with genuine stress incontinence. Urology. 2002;59(3):349–53.

    Article  Google Scholar 

  29. Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Lee J. Risk factors of treatment failure of midurethral sling procedures for women with urinary stress incontinence. Int Urogynecol J. 2010;21:149–55.

    Article  Google Scholar 

  30. Lo TS, Pue LB, Tan YL, Wu PY. Risk factors for failure of repeat mid-urethral sling surgery for recurrent or persistent stress urinary incontinence. Int Urogynecol J. 2016;27:923–31.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China

    Tsia-Shu Lo

  2. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung & Taipei, Medical Center, Keelung and Taipei, Taiwan, Republic of China

    Tsia-Shu Lo

  3. Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China

    Tsia-Shu Lo

  4. Department of Obstetrics and Gynaecology, Peoples Education Society Medical College and Research Centre, Kuppam, Andhra Pradesh, India

    Nagashu Shailaja

  5. Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KcSH, KPJ Healthcare Group, Kuching, Sarawak, Malaysia

    Yiap Loong Tan

  6. Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan

    Ming-Ping Wu

  7. Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan

    Ming-Ping Wu

  8. Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines

    Sandy Chua

  9. Department of Obstetrics & Gynaecology, National University Hospital of Singapore, Singapore, Singapore

    Kwok Weng Roy

Authors
  1. Tsia-Shu Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nagashu Shailaja
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yiap Loong Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ming-Ping Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandy Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kwok Weng Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsia-Shu Lo.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lo, TS., Shailaja, N., Tan, Y.L. et al. Outcomes and failure risks in mid-urethral sling insertion in elderly and old age with urodynamic stress incontinence. Int Urogynecol J 31, 717–726 (2020). https://doi.org/10.1007/s00192-019-04171-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-04171-w

Keywords

Search

Navigation