OBJECTIVE - To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline.
METHODS - This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data.
RESULTS - Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P=.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P=.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery.
CONCLUSIONS - Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement.
LEVEL OF EVIDENCE - II.
Obstet Gynecol. 2015 Aug;126(2):423-30. doi: 10.1097/AOG.0000000000000929.
Zyczynski HM1, Albo ME, Goldman HB, Wai CY, Sirls LT, Brubaker L, Norton P, Varner RE, Carmel M, Kim HY; Urinary Incontinence Treatment Network.
University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania; the University of California San Diego Health Systems, San Diego, California; Cleveland Clinic, Cleveland, Ohio; the University of Texas Southwestern, Dallas, Texas; William Beaumont Hospital, Royal Oak, Michigan; Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; the University of Utah, Salt Lake City, Utah; the University of Alabama at Birmingham, Birmingham, Alabama; and New England Research Institutes, Watertown, Massachusetts.