Prediction of Mid-Urethral Sling Failure with Clinical Findings and Urodynamics

Objective: Mid-urethral slings (MUS) become a standard, minimally invasive surgery to treat urinary stress incontinence. Our aim is to investigate the contribution of preoperative urodynamics to mid-urethral slings success and determine predictors for choosing mid-urethral sling route.

Methods: Women with stress urinary incontinence and who desired surgical correction of their incontinence were included in the study. The selection of the procedure was according to an algorithm used in an institution. Urodynamic and baseline factors that may be associated with surgery failure were analyzed.

Results: A total of 159 patients in the tension free transvaginal tape (TVT) group and 83 patients in the transobturator tape (TOT) group were included in the present study. Urodynamic findings of subjects who were considered MUS failure were not significantly different from those women who were continent after 1 year of surgery. Detrusor overactivity was present on urodynamics in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test (P < 0.05). A vaginal hysterectomy had been performed on 13 of 37 (35.1%) subjects with MUS failure 1 year after operation, and 20 of 205 subjects (9.8%) in the stress urinary incontinence (SUI) continent group (P < 0.001).

Conclusions: Preoperative detrusor overactivity (DO) was the only urodynamic finding that negatively affected the success of surgery in both TOT and TVT groups. Our study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse.