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Predictors for persistent urodynamic stress incontinence following extensive pelvic reconstructive surgery with and without midurethral sling

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Abstract

Introduction and hypothesis

The objective of this study was to identify the predictors for persistent urodynamic stress incontinence (P-USI) in women following extensive pelvic reconstructive surgery (PRS) with and without midurethral sling (MUS).

Mmethods

A total of 1,017 women who underwent pelvic organ prolapse (POP) surgery from January 2005 to December 2013 in our institutions were analyzed. We included 349 USI women who had extensive PRS for POP stage III or more of whom 209 underwent concomitant MUS.

Results

Of the women who underwent extensive PRS without MUS, 64.3 % (90/140) developed P-USI compared to only 10.5 % (22/209) of those who had concomitant MUS. Those with concomitant MUS and PRS alone were at higher risk of developing P-USI if they had overt USI [odds ratio (OR) 2.2, 95 % confidence interval (CI) 1.3–4.0, p = 0.014 and OR 4.7, 95 % CI 2.0–11.3, p < 0.001, respectively], maximum urethral closure pressure (MUCP) of < 60 cm H2O (OR 5.0, 95 % CI 3.0–8.1, p < 0.001 and OR 5.3, 95 % CI 2.7–10.4, p < 0.001, respectively), and functional urethral length (FUL) of < 2 cm (OR 5.4, 95 % CI 2.7–8.8, p < 0.001 and OR 3.9, 95 % CI 2.4–6.9, p < 0.001, respectively). Parity ≥ 6 (OR 3.9, 95 % CI 1.7–5.2, p < 0.001) and Prolift T (OR 3.1, 95 % CI 1.9–4, p < 0.001) posed a higher risk of P-USI in those with concomitant surgery. Perigee and Avaulta A seemed to be protective against P-USI in those without MUS.

Conclusions

Overt USI with advanced POP together with low MUCP and FUL values have a higher risk of developing P-USI. Therefore, counseling these women is worthwhile while considering the type of mesh used.

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Acknowledgments

Many thanks to all the colleagues for their contribution to this study.

Conflicts of interest

None.

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 & Pei-Ying Wu

  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 Hsien, Taiwan, 333, Republic of China

    Tsia-Shu Lo

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

    Tsia-Shu Lo

  4. Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China

    Enie Akhtar Nawawi, Nazura bt Karim & Ahlam Al-Kharabsheh

  5. Department of Obstetrics and Gynecology, Hospital Raja Perempuan Zainab II, Kota Bahru, Kelantan, Malaysia

    Enie Akhtar Nawawi

  6. Department of Obstetrics and Gynecology, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

    Nazura bt Karim

  7. Department of Obstetrics and Gynecology, Mu’tah university, Al-Karak, Jordan

    Ahlam Al-Kharabsheh

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  1. Tsia-Shu Lo
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  2. Enie Akhtar Nawawi
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Correspondence to Tsia-Shu Lo.

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Lo, TS., Nawawi, E.A., Wu, PY. et al. Predictors for persistent urodynamic stress incontinence following extensive pelvic reconstructive surgery with and without midurethral sling. Int Urogynecol J 27, 399–406 (2016). https://doi.org/10.1007/s00192-015-2837-z

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  • DOI: https://doi.org/10.1007/s00192-015-2837-z

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