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Outcomes of urodynamic mixed urinary incontinence and urodynamic stress incontinence with urgency after mid-urethral sling surgery

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Abstract

Introduction and hypothesis

Mixed urinary incontinence (MUI) is defined as symptomatic complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing. The paucity of research, especially on the surgical management of MUI, limits its best management.

Methods

This is a retrospective study to determine the outcomes of mixed urinary incontinence after mid-urethral sling surgery with two groups, urodynamic stress incontinence (USI) with urgency and urodynamic mixed urinary incontinence (MUI-UD; USI and detrusor overactivity [DO]).

Results

Ninety women (USI + urgency group) with preoperative USI and urgency and no demonstrable DO/DOI attained an objective cure of 82.2%, whereas the remaining 67 (MUI-UD group) women with both USI and DO/DOI were reported to have an objective cure of only 55.2%. Subjective cures were 81.1% and 53.7% respectively. The type of incontinence surgery does not affect postoperative outcomes in either of the groups. Demographic factors identified to have a significant negative effect on cure rates were postmenopausal status (p = 0.005), prior hysterectomy (p = 0.028), pre-operative smaller blafdder capacity (p = 0.001), and a larger volume of pre-operative pad test (p = 0.028). A lower mid-urethral closure pressure (MUCP) was significant with post-operative failure of treatment with MUI-UD group (68.8 ± 36.2 cmH2O vs 51.9 ± 24.7 cmH2O; p = 0.033).

Conclusions

Although there is evidence for a good cure of the stress component of MUI, urodynamic investigation with its findings prior to management of MUI could have greater implications for selective patient centered counseling. Presence of DO or DOI on urodynamics resulted in poorer objective and subjective outcomes.

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Author information

Authors and Affiliations

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

    Tsia-Shu Lo & Wu-Chiao Hsieh

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

    Tsia-Shu Lo & Wu-Chiao Hsieh

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

    Tsia-Shu Lo

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

    Yiap Loong Tan

  5. Department of Obstetrics and Gynecology, Subang Jaya Medical Centre, Petaling Jaya, Selangor, Malaysia

    Leng Boi Pue

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

    Sandy Chua

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

    Ming-Ping Wu

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

    Ming-Ping Wu

Authors
  1. Tsia-Shu Lo
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  2. Yiap Loong Tan
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  3. Leng Boi Pue
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  4. Sandy Chua
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  5. Ming-Ping Wu
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  6. Wu-Chiao Hsieh
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Contributions

TSL: protocol/project development, data collection, data analysis, manuscript editing; YLT: data analysis, manuscript writing, manuscript editing; LBP: data analysis, manuscript editing; SC: data analysis, manuscript editing; MPW: data analysis, manuscript editing; WCH: data collection, data analysis.

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Correspondence to Tsia-Shu Lo.

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Lo, TS., Tan, Y.L., Pue, L.B. et al. Outcomes of urodynamic mixed urinary incontinence and urodynamic stress incontinence with urgency after mid-urethral sling surgery. Int Urogynecol J 31, 1949–1957 (2020). https://doi.org/10.1007/s00192-019-04213-3

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  • DOI: https://doi.org/10.1007/s00192-019-04213-3

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