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Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence?

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Abstract

Introduction and hypothesis

Midurethral sling (MUS) can improve overactive bladder (OAB) symptoms. It is unclear if anterior/apical prolapse (AA) repair provides additional benefit. We hypothesized that women with mixed urinary incontinence (MUI) experience greater improvement in the OAB component of their symptoms after concomitant MUS and AA repair compared with MUS alone.

Methods

This is a retrospective cohort study of women with bothersome MUI (defined by objective stress test and validated questionnaire) undergoing MUS alone (“MUS-only”) or concomitant MUS and AA repair (“MUS + AA”). Our primary outcome was the Overactive Bladder Questionnaire Symptom Severity (OAB-q SS) change score 6 weeks after surgery.

Results

Of 151 women, 67 (44 %) underwent MUS-only and 84 (56 %) underwent MUS + AA. The MUS-only cohort was younger and had less severe baseline prolapse (p < 0.05 for both). Postoperative complications (predominantly UTI) occurred in 35 (23 %) patients and were similar between cohorts. For all subjects mean OAB-q SS scores significantly improved postoperatively (p < 0.05). Our primary outcome, OAB-q SS change score, showed no significant differences between cohorts (30 ± 26 MUS-only vs 25 ± 25 MUS + AA, p = 0.20), indicating similar improvements in OAB symptoms. Multivariate linear regression analysis revealed no difference in OAB-q SS change score between cohorts; however, OAB-q SS change scores were lower for women with a postoperative complication (β = −19, 95 % CI −31 to −6; p < 0.01).

Conclusions

In women with bothersome MUI, concomitant AA repair does not result in additional improvement in OAB symptoms over MUS alone. Patients with postoperative complications exhibit less improvement in OAB symptoms.

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Abbreviations

AA:

Anterior/apical prolapse

BMI:

Body mass index

CRADI:

Colorectal-Anal Distress Inventory

DO:

Detrusor overactivity

EBL:

Estimated blood loss

HRQL:

Health-related quality of life

IQR:

Interquartile range

MUS:

Midurethral sling

OAB:

Overactive bladder

OAB-q:

Overactive Bladder Questionnaire

PFDI:

Pelvic Floor Distress Inventory

POP:

Pelvic organ prolapse

POP-Q:

Pelvic organ prolapse quantification

POPDI:

Pelvic Organ Prolapse Distress Inventory

REDCap:

Research Electronic Data Capture

SS:

Symptom severity

SUI:

Stress urinary incontinence

UDI:

Urinary Distress Inventory

UDS:

Urodynamic studies

UI:

Urinary incontinence

UUI:

Urgency urinary incontinence

UTI:

Urinary tract infection

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Acknowledgements

The authors would like to thank Grace Fulton for data collection and research support.

Funding

No funding was received for this study.

Conflicts of interest

A.A. Dieter: AUGS Thomas Benson Neuromodulation Grant, NIH/NIDDK Loan Repayment Program; A.E. Edenfield: AUGS Foundation Fellow Research Award; A.C. Weidner: none; P.J. Levin: none; N.Y. Siddiqui: Medtronic, Inc., Intuitive Surgical Inc., Fundamentals of Robotic Surgery, NIH/NIDDK 1K12 DK10024-01.

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Authors and Affiliations

  1. Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Drive Suite 310, Durham, NC, 27707, USA

    Alexis A. Dieter, Autumn L. Edenfield, Alison C. Weidner, Pamela J. Levin & Nazema Y. Siddiqui

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  1. Alexis A. Dieter
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  2. Autumn L. Edenfield
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Correspondence to Alexis A. Dieter.

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Dieter, A.A., Edenfield, A.L., Weidner, A.C. et al. Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence?. Int Urogynecol J 25, 1269–1275 (2014). https://doi.org/10.1007/s00192-014-2400-3

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