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Outcomes of the Supris® Sling in an Urban Latina Population - Beyond the Abstract

To date, there are a relative lack of data on mid-urethral sling (MUS) outcomes among Latina women despite evidence supporting higher rates of urinary incontinence in this ethnic group.1,2 Furthermore, prior studies have demonstrated lower rates of anti-incontinence surgeries among non-white women.3 We previously studied the diversity of patients included in the studies used to develop the 2017 American Urological Association (AUA)/ Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) Surgical Treatment of Female Stress Urinary Incontinence Guideline.4,5 We found that non-white women were disproportionally not included in the published studies.5

We sought to compare patient-reported outcomes from a cohort of predominantly Latina women who underwent Supris retropubic MUS placement to those published in clinical trial literature. We performed a retrospective chart review to abstract demographics, baseline pre-operative characteristics, peri-operative and post-operative parameters during a 19-month period. Patient-reported outcome measures were obtained using the validated Spanish versions of the Urogenital Distress Inventory-6 (UDI-6) and Patient Global Impression of Improvement (PGI-I) questionnaires. The survey responses were analyzed using the nonparametric Wilcoxon Rank Sum Test.

Over 80% of the study participants were Latina women. The vast majority of patients reported pre-operative pad use and mixed urinary incontinence (MUI) with no post-operative pad use but persistent urge symptoms. Despite persistent post-operative urge symptoms, patients reported a high satisfaction rate based on PGI-I parameters. De novo overactive bladder (OAB) symptom rate (7%) was comparable to that reported in prior outcome studies. Almost 60% of women felt their pre-operative urinary urge symptoms improved. However, we did not analyze how well the urge symptoms were optimized before MUS placement.

Our findings help fill the current knowledge gap and provide data for counseling Latina and other minority women about MUS sling outcomes when considering SUI or MUI surgical treatment options. Additionally, we reported a very low rate of adverse outcomes requiring revision procedures and a high subjective cure rate using the Supris MUS.

Written by: Gabriela Gonzalez, MD, MPH1, Jonathan Perley, MD,2 and Jennifer T. Anger, MD, MPH3 

  1. Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
  2. California Medical Urology Group, Los Angeles, CA
  3. Department of Urology, University of California, San Diego School of Medicine, La Jolla, CA

References:

  1. Thom DH, van den Eeden SK, Ragins AI, et al. Differences in Prevalence of Urinary Incontinence by Race/Ethnicity. J Urol. 2006;175(1):259-264. doi:10.1016/S0022-5347(05)00039-X
  2. Leroy L da S, Lopes MHB de M, Shimo AKK. Urinary Incontinence in Women and Racial Aspects: A Literature Review. Texto e Context Enferm. 2012;21(3):692-701. doi:10.1590/S0104-07072012000300026
  3. Anger JT, Rodríguez L V., Wang Q, Chen E, Pashos CL, Litwin MS. Racial Disparities in the Surgical Management of Stress Incontinence Among Female Medicare Beneficiaries. J Urol. 2007;177(5):1846-1850. doi:10.1016/j.juro.2007.01.035
  4. Kobashi, K. C., Albo, M. E., Roger, R., Ginsberg, D. A., & Goldman, H. B. (2017). American Urological Association ( AUA ) / SURGICAL TREATMENT OF FEMALE STRESS URINARY INCONTINENCE : AUA / SUFU GUIDELINE American Urological Association ( AUA ) / Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction ( SUFU ) Stress. March, 1–33.
  5. Gonzalez, G., Dallas, K., Arora, A., Kobashi, K. C., & Anger, J. T. (2021). Underrepresentation of Racial and Ethnic Diversity in Research Informing the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Stress Urinary Incontinence Guideline. Urology. https://doi.org/10.1016/j.urology.2021.08.038

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