To investigate the long-term durability of retropubic suburethral sling procedure for female stress urinary incontinence (SUI) and to identify urodynamic factors that might predict long-term successful outcomes.
Totally 286 women who underwent a retropubic suburethral sling for SUI were enrolled in this retrospective survey. Most patients received uroflowmetry, post-void residual volume (PVR) study and standardized video urodynamic testing preoperatively and 6 months postoperatively in half of them. Surgical results, demographic characteristics, pre-operative and post-operative urodynamic parameters, and postoperative clinical manifestation were retrospectively analyzed. Urodynamic parameters that predict a failure outcome were investigated.
The median follow-up period was 10 years (4 to 29 years). The overall subjective cure rate was 80.8%. The success rates of the sling procedures at 3, 5, 10, 15, and 20 years were 89.2%, 87.7%, 78.8%, 68.6%, and 60.0%, respectively. Vaginal delivery and greater parity had negative influence on cure rate (P=0.004 and 0.013, respectively). A significant interaction was detected from the baseline to 6 months between successes and failures for maximum flow rate (Qmax) (p=0.007), voided volume (p=0.020) and bladder outlet obstruction index (BOOI) (p=0.001). Univariate analysis revealed significant decrease of Qmax, volume and voiding efficiency; and increase of PVR, detrusor pressure and BOOI in patients with successful outcome. However, multivariate logistic regression failed to find predictive factors for a failure suburethral sling procedure.
Retropubic suburethral sling has a durable long-term effect for SUI. Slightly increased bladder outlet resistance after retropubic suburethral sling might be helpful for achieving long-term dryness.
Urology. 2019 May 28 [Epub ahead of print]
Hsin-Ho Liu, Hann-Chorng Kuo
Department of Urology, Buddhist Tai-Chung Tzu Chi General Hospital. Electronic address: ., Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan. Electronic address: .