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Outcomes of Mid-Urethral Sling for Urodynamic Stress Incontinence Following Extensive Pelvic Reconstructive Surgery

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Abstract

Introduction and Hypothesis

To assess the outcomes of mid-urethral sling (MUS) procedures for urodynamic stress incontinence (USI) following extensive pelvic reconstructive surgery (PRS) and identify risk factors for persistent USI (P-USI).

Methods

This retrospective study analyzed 84 women who underwent a staged approach to MUS for USI after PRS for advanced pelvic organ prolapse (Pelvic Organ Prolapse Quantification III and IV). The primary outcome was objective cure rate, defined by negative urine leakage on urodynamic study and a 1-h pad test weight of < 2 g. Subjective cure rate was through a negative response to question 3 of UDI-6.

Results

The overall objective cure rate was 81.0%. The highest cure rate was observed in de novo USI (MUS-D; 89.7%) compared with women with persistent USD (MUS-P). Patients with overt SUI exhibited lower cure rates than those with occult SUI. Predictive factors for persistent USI were lower pre-operative maximum urethral closure pressure (MUCP; p = 0.031) and higher BMI in the MUS-P group than in the MUS-D group (p = 0.008). Subjective improvement was noted, especially in the MUS-D group, with a subjective cure rate of 78.6%. Those with MUS-D reported a higher impact on patient well-being post-surgery. No complications were observed after MUS surgery at follow-up.

Conclusions

Overt USI, low MUCP and high BMI are independent predictors of persistent USI after a staged MUS approach after pelvic reconstructive surgery.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

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Author information

Authors and Affiliations

  1. 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, 333, Taiwan

    Tsia-Shu Lo & Wu-Chiao Hsieh

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

    Tsia-Shu Lo

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

    Tsia-Shu Lo & Wu-Chiao Hsieh

  4. International Medical Center (IMC) Hospital, Women Health Center, Jeddah, Saudi Arabia

    Aisha Alzabedi

  5. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Tucheng, Medical Center, Taipei, Taiwan

    Lan-Sin Jhang

  6. Department of Obstetrics & Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia

    Maherah Kamarudin

  7. Department of Obstetrics and Gynecolog, Ospital Ng Lipa, Lipa City, Batangas, Philippines

    Louiza Erika Rellora

Authors
  1. Tsia-Shu Lo
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  2. Aisha Alzabedi
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  3. Lan-Sin Jhang
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  4. Wu-Chiao Hsieh
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  5. Maherah Kamarudin
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  6. Louiza Erika Rellora
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Contributions

T.-S. Lo: protocol/project development, data collection, data analysis, manuscript editing; A. Alzabedi: manuscript writing and editing; L.-S. Jhang: data collection; W.-C. Hsieh: data collection; M. Kamarudin: data collection; L.E. Rellora: manuscript editing.

Corresponding author

Correspondence to Tsia-Shu Lo.

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Ethical/Institutional Review Board Approval

This study was approved by the Chan Gung Memorial hospital Review Board (IRB:202400754B0), please see the attached file in the supplementary materials.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

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Lo, TS., Alzabedi, A., Jhang, LS. et al. Outcomes of Mid-Urethral Sling for Urodynamic Stress Incontinence Following Extensive Pelvic Reconstructive Surgery. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05918-w

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  • DOI: https://doi.org/10.1007/s00192-024-05918-w

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