Factors Influencing the Outcome of Mid Urethral Sling Procedures for Female Urinary Incontinence

Abstract

We evaluated the outcome at least 6 months after the tension-free vaginal tape or transobturator tape procedure in women with urinary incontinence, and identified factors predicting persistent stress urinary incontinence. A total of 464 women 28 to 80 years old (mean age 56) were included in the study. Tension-free vaginal tape (252) and transobturator tape (212) procedures were performed by the same surgeon. Mean followup was 10.8 months (range 6 to 52). Bladder perforations were noted in 12 patients (4.8%) in the tension-free vaginal tape group but there was no bladder perforation after the transobturator tape procedure (p = 0.001). The rate of urinary retention in the tension-free vaginal tape group was significantly higher than that in the transobturator tape group (15.1% vs 6.6%, p = 0.004). The overall cure rate was significantly higher in the tension-free vaginal tape group than in the transobturator tape group (92.1% vs 84.9%, p = 0.015). On multivariate analysis 4 variables were independent risk factors for persistent stress urinary incontinence, that is comorbid disease (OR 2.37, 95% CI 1.26-4.47, p = 0.008), urge urinary incontinence (OR 1.95, 95% CI 1.02-3.74, p = 0.044), severe grade of cystocele (OR 2.73, 95% CI 1.43-5.20, p = 0.002) and transobturator tape procedure (OR 2.87, 95% CI 1.50-5.47, p = 0.001). The cure rates in women with urinary incontinence are not similar after tension-free vaginal tape and transobturator tape procedures. Our findings suggest that characteristics including the type of procedure, comorbid diseases, mixed urinary incontinence and severe grade cystocele should be considered high risk factors for persistent stress urinary incontinence in these patients.