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Long term changes in Urine Flow among women with Retropubic sling for more than 5 years
IUGA Academy. Melendez Munoz J. Jun 30, 2018; 212816
Topic: Stress Incontinence
Joan Melendez Munoz
Joan Melendez Munoz

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273

Long term changes in urine flow among women with retropubic sling for more than 5 years

Melendez Munoz, J1; Rosamilia, A1; Edwards, G1; Leitch, A1; Ryan, G1; Lee, J1

1: Monash Health

Introduction: Although long term outcomes for mid-urethral retropubic slings (RMS) have already been published (1), reviewing the literature, no data is available regarding long term urine flow parameters of women who had RMUS in the past.

Objective: To assess long term voiding changes in patients with RMUS for more than 5 years.

Methods: Patients who had a RMS inserted before August 2011 were eligible to participate in the study. Women with chronic voiding dysfunction, neurological disease, failed retropubic sling after August 2011 but before follow up appointment and those who had non-retropubic sling were excluded. Those who fit the inclusion criteria were contacted and asked to participate in the study. They were invited to attend for a follow up consultation. All patients would be asked to fill in Patient Reported Outcome tools including: ICIQ UI SF, ICIQ OAB, PGII, and W-IPSS voiding questionnaire. Those who did not want or could not attend were sent the questionnaires by mail. Consultation included a vaginal examination to assess pelvic organ prolapse (POP) and mesh exposure. A cough stress test would be performed with a comfortable full bladder. A uroflowmetry test to assess their urine flow followed and then a bladder US scan to measure post void residual. All Data was collected on a standardized proforma including patient characteristics and statistical analysis was performed.

Results: 103 female patients accepted to participate in the study. Mean age was 70 +/- 10 years old. Mean age at the time of surgery of 63 +/- 11 years old. The mean follow up was 86.6 +/- 17.6 months. 10 patients had had previous incontinence surgery, 6 had a midurethral sling and 4 had a Burch colposuspension. Only 10 patients had concomitant surgery at the time. Preoperative urodynamics confirmed SUI in all patients. Median (IQR, 25%-75%) maximal urethral closure pressure (MUCP) was 20 (14 – 27) and Median (IQR, 25%-75%) abdominal leak point pressure (ALPP) was 60 (40 – 76). Detrusor overactivity (DO) was a urodynamic finding in 10 patients.

Table 1 shows Subjectives and Objectives outcomes at follow up as well as Uroflow parameters before and after surgery.

Subjective and Objective

SUI cure rates

>5 years after retropubic sling (n=103)

Reported SUI – ICIQ UI (c/e/ce)

36 (35%)

PGI-I, Median (IQR, 25-75%)

2 (1-3)

ICIQ UI, Median (IQR, 25-75%)

4 (3 – 10)

ICIQ OAB, Median (IQR, 25-75%)

5 (3 – 7)

W-IPSS, Median (IQR, 25-75%)

12 (5 – 19)

Uroflow

Before surgery

At follow up (n=28)

P value

Volume (mls) Median (IQR, 25-75%)

180 (101 – 38)

160 (107-275)

0.32

Qmax (mls/sec) Median (IQR, 25-75%)

23 (14 – 34)

13 (9 – 19)

0.0022

PVR (mls) Median (IQR, 25-75%)

20 (5 – 50)

57 (30 – 74)

0.0018

Conclusions: Retropubic midurethral slings may alter patients voiding parameters in the long term but without clinical significance.

References:

  1. NilssonCG,PalvaK,Aarnio R,MorcosE,Falconer C. Seventeen years' follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J.2013 Aug;24(8):1265-9. doi: 10.1007/s00192-013-2090-2. Epub 2013 Apr 6.

Disclosure:

Work supported by industry: no.

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