Surgical results in women with detrusor underactivity and stress urinary incontinence undergoing suburethral sling procedure—Predictive factors for successful outcome

Abstract

Objectives: To elucidate the treatment results and predictors for successful outcome in women with detrusor underactivity (DU) and stress urinary incontinence (SUI) undergoing suburethral sling procedure.Methods: Medical records of women with coexistent SUI and DU treated with a suburethral sling were retrospectively reviewed and we analyzed the association between treatment outcome and baseline demographics including etiology of DU and urodynamic variables. Patients who were dry and could urinate spontaneously were considered successful. Treatment failure was considered in those who were dry but needing clean intermittent catheterization (CIC) and patients who were still wet.Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7)scores were used to assess the impact of surgery on the quality of life.Results: Among 71 patients, a successful outcome was noted in 39 (55%), failed outcome with CIC in 15 (21%), and totally treatment failure in 17 (24%). Treatment outcome did not differ among the etiology subgroups. Overall, UDI-6 and IIQ-7 scores significantly improved after surgery. Multivariable logistic regression analysis revealed that the IIQ-7 and maximum flow rate (Qmax) were two independent predictors for improvement after surgery. An IIQ-7 score ≤6, and Qmax ≥6 mL/s can predict improvement by receiver operating characteristic analysis. Qmax ≤6 mL/s can predict needing CIC after surgery.Conclusions: For women with SUI and coexistent DU who underwent suburethral sling procedure, low IIQ-7 (≤6) scores and higher Qmax (≥6 mL/s) are predictors for improvement of surgical outcome. A Qmax of <6 mL/s was the only predictor for CIC after surgery. K E Y W O R D S detrusor underactivity, incontinence, sling surgery, urodynamics

Management of Urinary Incontinence With Underactive Bladder: A Review

“…CIC for voiding dysfunction after anti-incontinence surgery is conducted 3 to 4 times daily until the PVR decreases to less than 100 mL or is at most half of the voided volume [33]. Although the results may vary depending on the preoperative patient characteristics, more than 20% of the patients required CIC after a MUS in a study of SUI patients with DU who had more than 180 mL mean preoperative PVR [16]. Incontinence patients with UAB who can only empty their bladder through CIC are more likely to maintain CIC after incontinence treatment.…”

“…The 10-year continence rate in DU was 79.4%, which was not different from the outcomes of the patients with stable bladder or DO. Another study elucidating the outcome of retropubic MUS in SUI with DU showed that 76% of the patients had clinical improvement in their SUI, but 21% of the patients needed clean intermittent catheterization (CIC) to empty their bladder [ 16 ]. DU was defined by a PdetQmax of <20 cm H 2 O and a Qmax of <15 mL/sec in that study.…”

Detrusor underactivity and complicated stress urinary incontinence: a cross-data study

“…Different studies showed that DUA could be related to a prolonged return to normal voiding and higher post-operative urinary complications [ 19 , 25 ]. Others found that preoperative Pdet/Qmax [ 18 ] or Qmax [ 20 ] could be predictive factors of a negative effect of DUA on SUI surgical outcomes. However, the lack of correlation between DUA and the type of SUI did not allow an assessment of whether DUA or C-SUI affected the voiding complications.…”

“…C-SUI and DUA are recognized as potential conditions affecting MUS results; however, available studies have assessed these factors only separately, not analysing the relationship between C-SUI and DUA and the potential impact of DUA on the results of the type of SUI [ 18 , 19 , 20 ]. Our research aimed to clarify the influence of each of these conditions – the type of SUI and detrusor impairment – on MUS positioning.…”

A Precision Urodynamic Diagnosis is Essential for Successful Treatment of Lower Urinary Tract Dysfunction

“…Without a preoperative UDS or video UDS to identify DO, anti-incontinence treatment might fail to completely eradicate incontinence [5] . In addition, BOO and DU can also coexist in women with ISD and women might urinate efficiently because of low urethral resistance [4] , [6] . These LUTDs might become prominent after anti-incontinence surgery, and patients might need revision after surgery.…”