Midurethral sling (MUS) is an effective treatment for stress urinary incontinence (SUI). Despite the cure of SUI, several women need additional treatment due to de novo or persistent lower urinary tract symptoms (LUTS). Medical treatment due to LUTS after MUS may reduce patients’ satisfaction with surgery outcomes. However, there were few studies about medication due to LUTS after MUS. Therefore, we analyzed the association between preoperative LUTS and other patients' medical conditions and additional treatment after MUS using national health data.

We used nationwide claims data from the Health Insurance Review and Assessment Services database from January 2007 to December 2018. All diagnoses were coded according to the International Classification of Diseases, Tenth Revision (ICD-10). Association between preoperative voiding dysfunction and other comorbidities and postoperative medication after MUS was analyzed with the Kaplan-Meier method, and the difference in the survival curves was confirmed by log-rank test. . The risk for medication-related to MUS was estimated with Cox's proportional-hazard model.

A total of 294,956 women over 18 years old were included in this analysis. Almost 75% of the subjects were in their 40s or 50s. Eighteen (52,453/294,956) percent of women needed to take medicine within 90 days after surgery. Of women with postoperative medication, 43 (22,38./52,453)% of them took LUTS-associated medication before MUS, and 57 (30,070/52,453) % did not take LUTS-associated medicine before MUS. Of the women without preoperative medication associated with LUTS, 13 (30,070/244,060)% of them received LUTS-associated medication within 90 days after LUTS. Older age is a risk factor for the additional medication after MUS. About 30% of women were also treated due to overactive bladder (OAB) and neurogenic bladder (NB), and 61% took medicine such as anticholinergics, β3-agonist, or alpha-blockers before MUS. Additional medication after MUS was significantly higher in women with OAB or NB and medicines before surgery. Other comorbidities were observed in 71% of women before MUS. Dementia, Parkinson's disease, sleep disturbance, mental illness, fibromyalgia were risk factors for the additional medicine after MUS. About 18% of women did not have any comorbidities (urologic and non-urologic) before MUS took medicine after surgery.

Age, preoperative LUTS, other medical comorbidities are risk factors for LUTS after MUS. Moreover, some women without urologic and non-urologic disorders before MUS experience de novo LUTS and need medical treatment.

Several women experience LUTS after MUS even though SUI is cured after MUS. Moreover, the present study shows that de novo LUTS which needs medical treatment is common. SUI is LUTS associated with aging; therefore, concomitant other LUTS and medical or neurologic diseases are also common in women with SUI. And these preoperative characteristics could be important factors affecting the LUTS after MUS. Therefore, careful assessment and counseling are necessary to decide on MUS and improve patients' satisfaction.

Neurourol Urodyn 2020;39:2455-2462
Neurourol Urodyn 2018;37:83-88