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Jeong, Hwang, Kim, Lee, Min, Han, Hong, Byun, and Lee: Are Risk Factors for Failure after Mid-Urethral Sling Operation Different between Patients with Pure Stress and Those with Mixed Urinary Incontinence in the Short-Term Follow-Up?
Original Article
Female Urology
Korean Journal of Urology

Korean Journal of Urology 2009; 50(6): 573-580.

Published online: 20 June 2009

DOI: https://doi.org/10.4111/kju.2009.50.6.573

Are Risk Factors for Failure after Mid-Urethral Sling Operation Different between Patients with Pure Stress and Those with Mixed Urinary Incontinence in the Short-Term Follow-Up?

Seong Jin Jeong, In Sik Hwang, Seong Soo Kim, Seung Tae Lee, Kyung Eun Min, Byung Kyu Han, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee

Department of Urology, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.

Correspondence to: Sang Eun Lee. Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam 463-707, Korea. TEL: 031-787-7349, FAX: 031-787-4057, urology@snu.ac.kr

Received 1 December 2008       Accepted 15 May 2009

Copyright © The Korean Urological Association, 2009

Abstract

Purpose

Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI.

Materials and Methods

Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery.

Results

The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis.

Conclusions

Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI.

Keywords: Stress urinary incontinence, Urge urinary incontinence, Suburethral slings, Risk factors

Figures and Tables

Table 1
Demographic characteristics of the patients according to the type of incontinence
kju-50-573-i001

SUI: stress urinary incontinence, MUI: mixed urinary incontinence, BMI: body mass index, QoL: quality of life, PVR: post-void residual, MUCP: maximal urethral closure pressure, IDC: involuntary detrusor contraction, VLPP: Valsalva leak point pressure, a: Student's t-test, b: chi-square test, Data presented are Mean±SE or number (%)

Table 2
Comparison of the clinical outcomes and subjective satisfaction
kju-50-573-i002

SUI: stress urinary incontinence, MUI: mixed urinary incontinence, a: chi-square test

Table 3
Comparison of the type of persistent incontinence
kju-50-573-i003

SUI: stress urinary incontinence, MUI: mixed urinary incontinence, a: chi-square test, One patient showed both stress and urgency incontinence in SUI group, and six patients in MUI group

Table 4
Univariate & multivariate analysis for risk factors for failure of surgery in the SUI and MUI groups
kju-50-573-i004

OR: odds ratio, CI: confidence interval, SUI: stress urinary incontinence, MUI: mixed urinary incontinence, VLPP: Valsalva leak point pressure, QoL: quality of life, IDC: involuntary detrusor contraction

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