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Effect of Intrinsic Sphincter Deficiency on Midurethral Sling Outcomes in Women With Mixed Urinary Incontinence

Kassis, Nadine C. MD*; Washington, Blair B. MD, MHA; Korbly, Nicole B. MD; Lopes, Vrishali V. MS§; Sung, Vivian W. MD, MPH

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0b013e31827cd5e2
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Abstract

Objective: The objective of this study was to estimate the effect of intrinsic sphincter deficiency (ISD) on frequency and urge incontinence after midurethral sling (MUS) in women with mixed urinary incontinence (MUI).

Methods: We performed a retrospective study of 137 women with MUI who underwent MUS placement. We defined MUI as an affirmative response to the urge incontinence item (no. 16) on the Pelvic Floor Distress Inventory in a cohort of women with urodynamic stress incontinence. Intrinsic sphincter deficiency was defined as preoperative positive leak point pressure of less than 60 cm H2O and/or urethral closure pressure less than 20 cm H2O. Outcomes included resolution of frequency and urge incontinence as well as resolution of stress incontinence. Multivariable logistic regression was performed to estimate the association between ISD and urinary outcomes.

Results: One hundred thirty-seven women met our study inclusion criteria. Fifteen (11%) had preoperative ISD, and 122 (89%) did not. At 6 to 12 months after MUS placement, 67% of women with ISD-MUI versus 39% with non–ISD-MUI had complete resolution of both urinary frequency and urge incontinence (P = 0.04). The 2 groups did not differ postoperatively in regard to complete resolution of stress incontinence symptoms (85% vs 90%, P = 0.63). On regression analysis, women with ISD-MUI had increased odds of complete resolution of frequency and urge incontinence compared with women with non–ISD-MUI (adjusted odds ratio, 5.38 [95% confidence interval, 1.50–19.3]).

Conclusions: In women with MUI, preoperative ISD is associated with increased odds of urinary frequency and urge incontinence resolution after MUS.

In Brief

In women with mixed incontinence, preoperative intrinsic sphincter deficiency is associated with an increased odds of resolution of urinary frequency and urge incontinence after midurethral sling.

Author Information

From the *Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN; †Division of Urogynecology and Reconstructive Pelvic Surgery, Virginia Mason Medical Center, Seattle, WA; ‡Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, and §Division of Research, Women and Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI.

Reprints: Nadine C. Kassis, MD, Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Indiana University, 4721 Eagles Watch Dr, Indianapolis, IN 46254. E-mail: nkassis@iupui.edu.

Presented at the 38th Annual Scientific Meeting of the Society of Gynecologic Surgeons in Baltimore, MD, April 13, 2012.

The authors declare that they have nothing to disclose.

© 2013 by Lippincott Williams & Wilkins