Demographic risk factors for mid-urethral sling failure. Do they really matter?

Majkusiak, Wojciech; Pomian, Andrzej; Horosz, Edyta; Zwierzchowska, Aneta; Tomasik, Paweł; Lisik, Wojciech; Barcz, Ewa

doi:10.1371/journal.pone.0207185

Cited by 12 publications

(19 citation statements)

References 28 publications

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“…However, to date it is unknown whether these obstetrical factors such as delivery mode, obstetric anal sphincter injury, levator ani avulsion, and fetal factors also impact surgical outcomes in women with SUI. Parity is, to our knowledge, the only obstetrical factor previously studied [13,15]. Laterza et al evaluated the effect of parity at the time of surgery on short-and long-term outcomes in women who underwent SUI surgery by MUS [15].…”

Section: Discussionmentioning

confidence: 99%

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Previous obstetrical history does not impact short-term mid-urethral sling outcomes

et al. 2021

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Introduction and hypothesis Pregnancy and delivery are known risk factors for stress and mixed urinary incontinence. The most common surgical treatment is mid-urethral sling (MUS) surgery. This study evaluated the potential impact of the obstetrical history on the short-term subjective and objective failure rates after MUS surgery. Methods A registry-based surgical cohort study using data from the Medical Birth Registry of Norway (MBRN) and the national Norwegian Female Incontinence Registry (NFIR). Data from 14,787 women that underwent MUS surgery from 1998 to 2016 with complete registrations in the MBRN were included. Outcomes were 6–12-month postoperative subjective and objective failure rates. The potential impact of obstetrical and constitutional factors on both outcomes was tested in a multivariate logistic regression model. Results Several obstetrical variables seemed to impact both outcomes in the univariate analyses. However, in the multivariate analyses, none of the obstetrical variables significantly impacted subjective failure, and only being nulliparous before MUS surgery remained a risk factor for objective failure [aOR 1.60, (95% CI 1.07–2.40), p = 0.022]. High body mass index at time of surgery, non-retropubic slings, high preoperative urgency symptom load, and surgical complications were all strong risk factors for poor outcomes in the multivariate analyses. Conclusion Although childbirth is considered a risk factor for developing stress urinary incontinence, childbirth does not appear to affect the result of MUS in parous women. Our results suggest that nulliparous women with SUI may have a different pathophysiology than SUI after childbirth.

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Section: Discussionmentioning

confidence: 99%

“…Despite the high cure rates, there is still a group of women for whom the surgery fails in obtaining continence. Some of the risk factors identified are age at time of surgery, obesity, concomitant pelvic organ prolapse surgery, and surgical technique [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Previous obstetrical history does not impact short-term mid-urethral sling outcomes

et al. 2021

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“…Most studies covering the topic of obesity and SUI are retrospective and the findings are heterogeneous. A prospective observational study including 238 women who underwent retropubic MUS implantation with 12‐month follow‐up failed to find any difference in objective and subjective outcomes 10 . McKenna et al 24 followed a cohort of women for 5 years who underwent retropubic sling procedures and found significantly worse subjective and objective results in obese patients (98% vs 71%, P = .004).…”

Section: Discussionmentioning

confidence: 99%

“…A prospective observational study including 238 women who underwent retropubic MUS implantation with 12-month follow-up failed to find any difference in objective and subjective outcomes. 10 McKenna et al 24 followed a cohort of women for 5 years who underwent retropubic sling procedures and found significantly worse subjective and objective results in obese patients (98% vs 71%, P = .004). Berger et al 25 in a retrospective cohort of retropubic TVT subjects, found that obese women had…”

Section: Discussionmentioning

confidence: 99%

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta‐analysis

Barco‐Castillo

Zuluaga

Serrano

et al. 2020

Neurourology and Urodynamics

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Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. Materials and Methods: A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. Results: A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m 2) and nonobese (<30 kg/m 2). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. Conclusions: This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

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“…Surgical treatment is the preferred option for women with stress urinary incontinence in whom conservative management strategies have failed [11]. According to the available literature, mid-urethral slings are both more effective and safer than other surgical treatment modalities [12], with objective and subjective cure rates of retropubic TVT ranging from 71% to 97% [13,14]. There has also been an ongoing discussion considering other treatment options such as fascial slings.…”

Section: Discussionmentioning

confidence: 99%

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

Horosz¹,

Pomian²,

Zwierzchowska³

et al. 2020

JCM

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Pelvic organ prolapse (POP) often co-occurs with stress urinary incontinence. There is no consensus on whether prolapse repair and anti-incontinence surgery should be performed concomitantly or separately, in a two-step manner. The present study evaluated the effects of the tension-free vaginal tape (TVT) procedure in patients who had previously undergone pelvic floor repair (study group), compared to women who underwent TVT insertion only (control group). The study group comprised 84 patients who underwent the TVT procedure but had previously also undergone surgical POP repair. The control group consisted of 250 women in whom the TVT was inserted. The primary objective was to compare the objective cure rate and the secondary objective was to compare the subjective cure rate in both groups. Negative pad test was achieved in over 91% in both groups. Objective and subjective cure rates were compared, as well as complication rates. Significant improvement was observed in the postoperative 1-h pad test in all patients. In all patients, we observed significant improvement in the quality of life, with no differences between the groups. No differences were found in the occurrence of postoperative urinary retention, urgency and frequency of daytime micturition, or vaginal erosion between the groups. The current results demonstrate that the two-step approach to pelvic reconstruction and anti-incontinence surgery is as safe and effective as primary TVT implantation.

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Demographic risk factors for mid-urethral sling failure. Do they really matter?

Cited by 12 publications

References 28 publications

Previous obstetrical history does not impact short-term mid-urethral sling outcomes

Previous obstetrical history does not impact short-term mid-urethral sling outcomes

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta‐analysis

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure

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