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Analyzing the effect of trans-obturator mid-urethral sling in women with mixed urinary incontinence

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Dr Anita Kant    22 December 2017

A single-centre prospective study published in the European Journal of Obstetrics and Gynecology and Reproductive Biology showed that trans-obturator mid-urethral sling surgery can be performed in women with mixed urinary incontinence following unsuccessful conservative therapy. It is also noteworthy that menopause and age over 60 years were reported as risk factors for failure.

The study was conducted with an aim of assessing long-term subjective and objective outcomes related to continence and other urinary symptoms of a trans-obturator mid-urethral sling procedure. In addition, its impact on the quality of life and factors which influence outcomes were determined. The study cohort involved 86 women who underwent trans-obturator mid-urethral sling for mixed urinary incontinence, as defined by the International Continence Society (ICS)/International Urogynecological Association (IUGA). The results demonstrated that with a mean follow-up of 59 months, stress urinary incontinence (SUI) was cured in 83.7% patients objectively and 87.2% patients subjectively. 3 patients underwent further anti-incontinence surgery. The continence rates were 74.4% and 66.3% for urgency urinary incontinence (UUI) and SUI-UUI, respectively. The patient-reported success rate was reported to be 87.2%. Statistically significant improvements were observed in all domains except general health. The univariate analysis revealed no significant risk factor for persistence of SUI. Median age > 60 years and menopause were predictive for persistence of UUI. Median and mean age > 60 years were regarded as predictors of persistence of overall incontinence. On the other hand, in the multivariate model, all variables lost their statistical significance. Yet these factors must be considered while counselling pre-operatively.

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