Hsin-Ho Liu1, Hann-Chorng Kuo2. 1. Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan. 2. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan. Electronic address: hck@tzuchi.com.tw.
Abstract
OBJECTIVE: 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. MATERIALS AND METHODS: In total, 286 women who underwent a retropubic suburethral sling for SUI were enrolled in this retrospective survey. Most patients received uroflowmetry, postvoid residual volume study and standardized video urodynamic testing preoperatively and 6 months postoperatively in half of them. Surgical results, demographic characteristics, preoperative and postoperative urodynamic parameters, and postoperative clinical manifestation were retrospectively analyzed. Urodynamic parameters that predict a failure outcome were investigated. RESULTS: The median follow-up period was 10 years (4-29 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 = .004 and .013, respectively). A significant interaction was detected from the baseline to 6 months between successes and failures for maximum flow rate (Qmax) (P = .007), voided volume (P = .020), and bladder outlet obstruction index (P = .001). Univariate analysis revealed significant decrease of Qmax, volume, and voiding efficiency; and increase of postvoid residual volume, detrusor pressure, and bladder outlet obstruction index in patients with successful outcome. However, multivariate logistic regression failed to find predictive factors for a failure suburethral sling procedure. CONCLUSION: 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.
OBJECTIVE: 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. MATERIALS AND METHODS: In total, 286 women who underwent a retropubic suburethral sling for SUI were enrolled in this retrospective survey. Most patients received uroflowmetry, postvoid residual volume study and standardized video urodynamic testing preoperatively and 6 months postoperatively in half of them. Surgical results, demographic characteristics, preoperative and postoperative urodynamic parameters, and postoperative clinical manifestation were retrospectively analyzed. Urodynamic parameters that predict a failure outcome were investigated. RESULTS: The median follow-up period was 10 years (4-29 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 = .004 and .013, respectively). A significant interaction was detected from the baseline to 6 months between successes and failures for maximum flow rate (Qmax) (P = .007), voided volume (P = .020), and bladder outlet obstruction index (P = .001). Univariate analysis revealed significant decrease of Qmax, volume, and voiding efficiency; and increase of postvoid residual volume, detrusor pressure, and bladder outlet obstruction index in patients with successful outcome. However, multivariate logistic regression failed to find predictive factors for a failure suburethral sling procedure. CONCLUSION: 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.