Factors predicting treatment success in mixed urinary incontinence treated with midurethral sling

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY LUTS: Lower Urinary Tract Symptoms Pub Date : 2022-12-19 DOI:10.1111/luts.12471

Cuneyd Ozkurkcugil, Ibrahim Erkut Avci

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Abstract

Objectives

We aimed to investigate success rates and predictive factors for midurethral slings (MUS) in women with mixed urinary incontinence (MUI).

Methods

Women with MUI (urodynamically diagnosed detrusor overactivity and stress urinary incontinence) treated with MUS between 2013 and 2020 were retrospectively investigated. Prior to MUS, all participants completed bladder diary and questionnaires and underwent a urodynamic study. Six months after surgery, patients were evaluated for lower urinary tract symptoms with pelvic examination, pad test, and the 8-item Overactive Bladder Questionnaire (OAB-V8) and the International Consultation on Incontinence Questionnaire-Short-Form (ICIQ-SF). Success rates after MUS were determined separately according to the predominant component of MUI. In addition, multivariable logistic regression analysis was used to determine the most important independent variables affecting the surgical outcome.

Results

There were 117 participants. The overall MUI cure rate was 73.5%, but surgical success in the presence of postoperative urgency was 60.7%. Moreover, MUS success rate was 84.8% in those with preoperative stress-dominant MUI. However, the success rates for equally and urgency-dominant MUI were both 29.4%. Preoperative OAB-V8 score, symptom duration >9.5 years, and preoperative anticholinergic medication were risk factors for persistent urgency and urgency urinary incontinence (UUI) postoperatively (p < .05). In addition, diabetes mellitus (DM) for persistent urgency and voiding frequency (daily) for persistent UUI were predictive factors (p < .05).

Conclusions

MUS may be offered to women with stress-dominant MUI. However, postoperative urgency might change a patient's perception of treatment despite successful incontinence treatment. MUS does not appear to be a good option when MUI patients have a high OAB-V8 score, symptom duration >9.5 years, DM, or use of anticholinergic medication preoperatively.

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预测尿道中吊带治疗混合性尿失禁成功的因素

目的探讨混合性尿失禁(MUI)女性中尿道吊带术(MUS)的成功率及预测因素。方法回顾性分析2013 ~ 2020年接受MUS治疗的MUI(尿动力学诊断为逼尿肌过度活动和压力性尿失禁)患者。在MUS之前，所有参与者都完成了膀胱日记和问卷调查，并进行了尿动力学研究。术后6个月，通过盆腔检查、尿垫试验、8项膀胱过度活动问卷(OAB-V8)和国际尿失禁问卷简表(ICIQ-SF)评估患者下尿路症状。根据MUI的优势成分分别确定MUS后的成功率。此外，采用多变量logistic回归分析确定影响手术结果的最重要的自变量。结果共117名受试者。总体MUI治愈率为73.5%，但术后出现急症的手术成功率为60.7%。术前压力主导型MUI的手术成功率为84.8%。然而，同等和紧急主导型MUI的成功率均为29.4%。术前OAB-V8评分、症状持续时间(9.5年)和术前抗胆碱能药物治疗是术后持续性尿急和急迫性尿失禁(UUI)的危险因素(p < 0.05)。此外，糖尿病(DM)持续性尿急和排尿频率(每日)为持续性尿失禁的预测因素(p < 0.05)。结论压力主导型MUI患者可采用MUS治疗。然而，术后急迫性可能会改变患者对治疗的看法，尽管成功的失禁治疗。当MUI患者有较高的OAB-V8评分、症状持续时间(9.5年)、糖尿病或术前使用抗胆碱能药物时，MUS似乎不是一个好的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

LUTS: Lower Urinary Tract Symptoms UROLOGY & NEPHROLOGY-

CiteScore

3.00

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： LUTS is designed for the timely communication of peer-reviewed studies which provides new clinical and basic science information to physicians and researchers in the field of neurourology, urodynamics and urogynecology. Contributions are reviewed and selected by a group of distinguished referees from around the world, some of whom constitute the journal''s Editorial Board. The journal covers both basic and clinical research on lower urinary tract dysfunctions (LUTD), such as overactive bladder (OAB), detrusor underactivity, benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), urinary incontinence, pelvic organ prolapse (POP), painful bladder syndrome (PBS), as well as on other relevant conditions. Case reports are published only if new findings are provided. LUTS is an official journal of the Japanese Continence Society, the Korean Continence Society, and the Taiwanese Continence Society. Submission of papers from all countries are welcome. LUTS has been accepted into Science Citation Index Expanded (SCIE) with a 2011 Impact Factor.