Persistent overactive bladder after midurethral sling surgery:prevalence , timing and risk factors

Illiano E1, Trama F2, Rossi de Vermandois J1, Gioè M1, Vacilotto G1, Costantini E1

Research Type


Abstract Category

Overactive Bladder

Abstract 467
Open Discussion ePosters
Scientific Open Discussion Session 19
Thursday 28th September 2023
12:15 - 12:20 (ePoster Station 1)
Exhibit Hall
Grafts: Synthetic Overactive Bladder Stress Urinary Incontinence Surgery
1. Andrology and urogynecological Clinic. Santa Maria Terni Hospital, University of Perugia, 2. Urologic Clinic, Santa Maria delle Grazie,Pozzuoli,Naples

Ester Illiano



Hypothesis / aims of study
Persistent urgency or urgency urinary incontinence (UUI) can occur in patients with MUI who undergo surgery for SUI. The presence of overactive bladder after anti-urinary incontinence surgery could affect quality of life.Sometimes patients ,despite careful counselling are convinced that urgency or/and urge urinary incontinence disappears after surgery.Persistence could affect patient satisfaction.It might be useful to actually evaluate what the size of the problem is after stress urinary incontinence surgery in order to improve patient consuelling and expectations.
The aim was to evaluate the prevalence and the risk factors of persistent urgency and UUI after TOT
Study design, materials and methods
It   was a prospective study on female patients with SUI underwent TOT from 2002 to 2015.Exclusion criteria were as follows: women with pure SUI, diabetes or neurologic disease; POP ≥ stage II.Preoperative evaluation includes medical history, objective examination, dynamic urologic ultrasonography, urodynamic examination,according to ICS criteria .Follow-up visits are performed at 1 month,3,6,12 months after surgery and annually , with the same preoperative evaluations except for urodynamic examination which is performed at 6 months after surgery.Stress urinary incontinence was defined according to ICS standardization and classified according to the Ingelmann-Sundberg scale.Urinary symptoms were evaluated using the standardized questionnaire UDI6.TOT surgery was performed by an expert surgeon using the out-in transobturator technique originally described by Delorm.Objective cure for SUI was defined as the absence of urine leakage during the stress test. Subjective cure was defined by a “no answer” to question 3 of the UDI-6 questionnaire.The study was approved by the Ethics Committee of our institution. All patients signed informed
A total of 289 patients (56.2±10.7 y) were included in the study. Follow up was 155±85 months. Overall 110 had SUI concurrent OAB dry, and 179 had MUI. Patients in the MUI group were significantly older than those in the SUI with OAB dry group (60.5±10.55 vs 58.97±10.98, p=0.003). The MUI group had a higher BMI (BMI, 27.3±4.6 vs 25.75±3.4, p=0.002) and tended to be more overweight
(BMI ≥25 kg/m	2 , 31.8%) than the patients in the other group (11.8%). In the SUI with urgency group, the success rate was 81%, de novo UUI developed in 23 patients (20.9%), of these 16% after 4 years. Sixty-eight patients (62.3%) had resolved urgency.	 In those with persistent urgency (38.1%), the subjective severity of urgency was improved in 27, the same in 10, and aggravated in 5. In the MUI group the success rate was 78%, 111 patients (62%) had resolved UUI, with resolved urgency in 75 (41.8%) and remnant urgency in 27.In patients with residual urgency, symptoms were improved in 24 and the same in 3. Sixty-eight patients (37.9%) had persistent UUI. Among them, the degree of urgency was improved in 55, the same in 4, and aggravated in 13. Table 1 showed that the BMI≥25,age > 60 years, DO, previous pelvic surgery and use of anticholinergic, were risk factors for persistent urgency and UUI.
Interpretation of results
Our results are in agreement with the literature. The reported incidence of persistent OAB dry in women with SUI and OAB dry ranged from 2% to 40%.In women with SUI and UUI, 32% had persistent urgency incontinence. A possible explanation might be the result of ageing while the MUI was also associated with higher failure rates for SUI specific outcomes. It is possible that patients with MUI have a higher disease severity or even different pathophysiology than patients with pure SUI
Concluding message
It is important to identify women with SUI and MUI for an appropriate preoperative counselling about postoperative persistent urgency and urgency urinary incontinence
Figure 1
Funding NONE Clinical Trial No Subjects Human Ethics Committee ceas Helsinki Yes Informed Consent Yes
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