Patient related factors associated with long-term urinary continence after Burch colposuspension and pubovaginal fascial sling surgeries.

Academic Article

Abstract

  • PURPOSE: We examined preoperative and postoperative patient related factors associated with continence status up to 7 years after surgery for stress urinary incontinence. MATERIALS AND METHODS: Women randomized to Burch colposuspension or fascial sling surgery and assessed for the primary outcome of urinary continence 2 years after surgery were eligible to enroll in a prospective observational study. Survival analysis was used to investigate baseline and postoperative factors in the subsequent risk of stress urinary incontinence, defined as self-report of stress urinary incontinence symptoms, incontinence episodes on a 3-day diary or surgical re-treatment. RESULTS: Of the women who participated in the randomized trial 74% (482 of 655) were enrolled in the followup study. Urinary continence rates decreased during a period of 2 to 7 years postoperatively from 42% to 13% in the Burch group and from 52% to 27% in the sling group, respectively. Among the baseline factors included in the first multivariable model age (p = 0.03), prior stress urinary incontinence surgery (p = 0.02), menopausal status (0.005), urge index (0.006), assigned surgery (p = 0.01) and recruiting site (p = 0.02) were independently associated with increased risk of incontinence. In the final multivariable model including baseline and postoperative factors, Burch surgery (p = 0.01), baseline variables of prior urinary incontinence surgery (p = 0.04), menopausal status (p = 0.03) and postoperative urge index (p <0.001) were each significantly associated with a greater risk of recurrent urinary incontinence. CONCLUSIONS: Preoperative and postoperative urgency incontinence symptoms, Burch urethropexy, prior stress urinary incontinence surgery and menopausal status were negatively associated with long-term continence rates. More effective treatment of urgency urinary incontinence in patients who undergo stress urinary incontinence surgery may improve long-term overall continence status.
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    Keywords

  • Female, Follow-Up Studies, Humans, Menopause, Middle Aged, Postoperative Complications, Proportional Hazards Models, Recurrence, Reoperation, Risk Factors, Suburethral Slings, Survival Analysis, Urethra, Urinary Incontinence, Stress, Urinary Incontinence, Urge, Urodynamics
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    Authorlist

  • Richter HE; Brubaker L; Stoddard AM; Xu Y; Zyczynski HM; Norton P; Sirls LT; Kraus SR; Chai TC; Zimmern P
  • Start Page

  • 485
  • End Page

  • 489
  • Volume

  • 188
  • Issue

  • 2