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Abstract
Purpose
We wanted to investigate outcomes after midurethral sling (MUS) operations for treating women with mixed urinary incontinence (MUI) and we wanted to identify the factors for achieving a favorable outcome.
Materials and Methods
The retrospective data was collected for 279 women with MUI and who underwent a MUS operation with at least 2 years follow up. The following measures were recorded before MUS: a disease-specific validated questionnaire, 1-hour pad tests, standardized stress tests and urodynamic study. The patients were divided as followed; a predominance of bothering symptoms (stress-predominance, urgency-predominance) and the presence of detrusor overactivity (DO). The patients with DO were further classified into the high detrusor pressure (HPDO) group and the low pressure (LPDO) group with a reference level of 15cmH2O of maximum detusor pressure at which involuntary contraction occurred during filling cystometry. The patient's postoperative global impression of improvement, the Bristol Female Lower Urinary Tract Symptom (BFLUTS) score, improvement of stress incontinence (SUI) and urgency were analyzed.
Results
The overall success rate of SUI was 96.4%. The predominance of bothering symptoms or the presence of DO did not influence the over all SUI success rate. In a subgroup of women with DO, those women with LPDO showed a significantly higher SUI cure rate than those with HPDO. Urge incontinence resolved in 176 (63.1%) and it improved in 60 (21.5%), while it was aggravated or it persisted in 43 (15.4%). Women with stress-predominant MUI, DO and LPDO experienced better resolution of urgency incontinence, an improved quality of life (QoL) and a higher global impression of improvement.
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Table 1.
Characteristics and outcomes according to the predominant symptoms and the existence of detrusor overactivity on urodynamic study
Table 2.
The outcomes according to the maximum detrusor pressure in patients with detrusor overactivity
Table 3.
The patients' satisfaction according to postoperative urgency
Table 4.
Comparison of the postoperative BFLUTS score according to the predominant symptom, the presence of detrusor overactivity on urodynamic study and the degree of maximum detrusor pressure in the patients with detrusor overactivity
BFLUTS: Bristol Female Lower Urinary Tract Symptom, SMUI: stress predominant mixed urinary incontinence, UMUI: urgency predominant mixed urinary incontinence, BFLUTS-FS: filling factor, BFLUTS-VS: voiding factor, BFLUTS-IS: incontinent factor BFLUTS-sex: sexual factor, BFLUTS-QoL: quality of life factor, ∗: statistically significant (p＜0.05)
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