Does mid-urethral sling surgery improve the patients' mental status?
IUGA Academy. Kinjo M. Jun 30, 2018; 212883; 426 Topic: Dysfunctional Voiding
Dr. Manami Kinjo
Dr. Manami Kinjo

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Does mid-urethral sling surgery improve the patients’ mental status?

Kinjo, M1; Okegawa, T1; Nutahara, K1

1: kyorin university school of medicine

Introduction: Urinary incontinence (UI) is common health problem in female population. UI has a negative impact on many aspects of patients’ quality of life, including their daily activities, personal relationships, and mental health. Many studies have demonstrated a relationship between depression and UI. About 20-40% in female UI patients reported the depression symptoms. Based on the type of incontinence, some studies reported that the rate of depression was higher in urge UI and mixed UI patients than in stress UI. Moreover, some research showed treatment of UI improved not only UI symptoms but depression symptoms especially in urge UI and mixed UI treated by pharmacological treatment. However, we have a few reports about influence on treatment for stress UI surgery for mental status. Also, it is not clear whether surgical treatment for stress UI will improve the mental status such as depression/anxiety especially in long term.

Objective: The aim of this study is to evaluate the efficacy of mid-urethral sling surgery against stress UI and its effects on mental status of stress UI or stress UI dominant mixed UI patients.

Methods: A total of 82 female stress UI or stress UI dominant mixed UI patients who underwent mid-urethral sling(MUS) surgery (retropubic or transobturator) and followed up for 12 months were enrolled in this study. In order to examine the efficacy of the surgery and the patients’ mental status, the following tools were used to evaluate the patients before treatment and 12 months after treatment: the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), and the Hospital Anxiety and Depression Scale (HADS, a validated tool for detecting anxiety and depression in a non-psychiatric outpatient population). All subjects provided oral informed consent before entering the study. The Wilcoxon signed-rank test was used for the statistical analyses and p-values of <0.05 were considered statistically significant.

Results: The patients’ median age, median body mass index, and median parity values were 54 (range: 38-70) years, 23 (range: 16.8-34.9) kg/m2, and 2 (range: 0-3), respectively, and 51 patients (62.2%) were postmenopausal. At the baseline, 18 patients (22.0%) had been diagnosed with clinical anxiety (HADS-Anxiety score: 8), and 12 patients (14.6%) had been diagnosed with clinical depression (HADS-Depression score: 8). At 12 months postoperatively, the subjects’ median ICIQ-SF total score, and median HADS-Depression score were significantly improved compared with their baseline values (ICIQ-SF: 12.0→0.0, HADS-Depression: 3.5→2.0) (p<0.05), but the median HADS-Anxiety score had not improved significantly (3.5→3.0) (n.s.).

Conclusions: This study demonstrated that MUS surgery significantly improved UI and depression, but not anxiety, in stress UI or stress UI dominant mixed UI patients. It is assumed that the improvement of the patients’ UI symptom helped to relieve their depression. However, patients’ fear for recurrence of UI affected the HADS Anxiety score. To the best of our knowledge, this is the first report to evaluate the effects of MUS on both the UI and mental status of female stress UI or stress UI dominant mixed UI patients for relatively long term.


Work supported by industry: no.

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