Predictors of cure and overactive bladder syndrome after a mid-urethral sling procedure in women with stress urinary incontinence

Urinary incontinence is the complaint of any involuntary leakage of urine. Stress urinary incontinence is involuntary leakage of urine on effort. exertion, sneezing, or coughing. Urge urinary incontinence is involuntary leakage of urine accompanied by, or immediately preceded by, a strong desire to pass urine (void). Urgency with or without urge urinary incontinence and usually with frequency and nocturia is also termed overactive bladder syndrome. Mixed urinary incontinence is involuntary leakage of urine associated with both urgency and exertion, effort, sneezing, or coughing. Usually, one of these is predominant; that is, either the symptoms of urge incontinence or those of stress incontinence are most bothersome. Overflow incontinence occurs when the bladder becomes large and flaccid and has little or no detrusor tone or function. It is usually due to injury or insult, occurring post surgery or post-partum. The bladder simply leaks when it becomes full. Incontinence due to a fistula is incontinence resulting from a vesicovaginal, ureterovaginal, or urethrovaginal fistula. Congenital incontinence is incontinence due to congenital causes (e.g. an ectopic ureter).

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Predictors for De Novo Overactive Bladder after Readjustable Mid-Urethral Sling Procedure in Women with Stress Urinary Incontinence due to Intrinsic Sphincter Deficiency

BioMed Research International ◽

10.1155/2018/6934747 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Joo Hyun No ◽

Kyung Hwa Choi ◽

Dae Keun Kim ◽

Tae Heon Kim ◽

Seung Ryeol Lee

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Overactive Bladder ◽

De Novo ◽

Pelvic Organ ◽

Intrinsic Sphincter Deficiency ◽

Urinary Flow ◽

Sling Procedure ◽

Group 2 ◽

Sphincter Deficiency

Purpose. This study identified noninvasive factors that predict overactive bladder (OAB) after readjustable mid-urethral sling surgery (Remeex system) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Materials and Methods. We retrospectively reviewed the medical records of 130 women with SUI due to ISD [Valsalva leak-point pressure (VLPP) <60 cm H2O] who underwent the Remeex procedure between February 2011 and March 2017. Patients were classified according to OAB symptoms before and 6 months after the Remeex procedure: Group 1, without preoperative and postoperative OAB (n=46); Group 2, without preoperative OAB and with postoperative OAB (de novo OAB, n=15); Group 3, with preoperative OAB and without postoperative OAB (n=25); Group 4, with preoperative and postoperative OAB (n=44). Noninvasive clinical and urodynamic factors were evaluated as predictors of de novo OAB. Results. The four groups significantly differed with respect to age (p=0.036), peak urinary flow rate (PUFR) one month after surgery (post-PUFR, p=0.001), and postvoid residual (PVR) one month after surgery (post-PVR, p=0.005). No significant differences were detected for body mass index, diabetes, multiparity, menopause, previous hysterectomy, previous incontinence surgery, previous pelvic organ prolapse surgery, pyuria, preoperative PUFR, preoperative PVR, maximal cystometric capacity, VLPP, maximum urethral closure pressure, detrusor pressure at PUFR, and detrusor overactivity (p>0.05). Post-PUFR decreased significantly compared with preoperative PUFR in Groups 1, 2, and 4 (p=0.002, p=0.001, and p=0.001, respectively). Pairwise comparisons of post-PUFR and post-PVR revealed statistically significant differences between Group 2 and other groups (p<0.0125). Multivariate logistic regression analyses showed that post-PUFR was the only significant predictor of de novo OAB (odds ratio = 0.823, 95% confidence interval 0.727-0.931, p=0.002). Conclusions. Reduced PUFR after the Remeex procedure is a promising predictor of risk for de novo OAB. This metric is noninvasive and easy to measure.

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