ABSTRACT: We compared outcomes after midurethral sling (MUS) with and without concomitant repair for prolapse.
Women who underwent MUS with or without concomitant repair for prolapse completed a follow-up survey. Outcomes were assessed with validated questionnaires and medical record review. Kaplan-Meier, Cox proportional hazards regression, and logistic regression models were used for analysis.
Of 317 women, 281 (89%) responded to the survey. During a median follow-up of 2.7 years, survival free of "any" incontinence (Incontinence Severity Index score, >0) was similar in both groups (adjusted hazard ratio, 1.07; P = 0.77). Women with concomitant repair for advanced prolapse tended to be more bothered by frequent urination (adjusted odds ratio, 1.78; P = 0.08) and more likely to require urethrolysis (odds ratio, 6.11; P = 0.04) than those without concomitant pelvic floor repair.
Prolapse repairs concomitant with MUS did not affect incontinence recurrence. However, repairs may cause increased lower urinary tract symptoms.
International Urogynecology Journal 02/2011; 22(7):819-25. · 1.83 Impact Factor
ABSTRACT: The purpose of this study was to assess which preoperative and postoperative variables correlated with satisfaction after surgical treatment of urinary incontinence.
We conducted a retrospective cohort study of 371 women who underwent rectus fascial or midurethral sling procedure. Satisfaction was defined as a questionnaire response of "completely satisfied." Incontinence symptoms were based on responses to validated questionnaires. Associations between preoperative and postoperative variables and satisfaction were assessed with the use of logistic regression models.
Increasing patient age (odds ratio [OR], 0.8; P = .002), body mass index (OR, 0.8; P = .003), and an autologous rectus fascial sling (compared with a midurethral sling; OR, 0.5; P = .003) were associated with decreased odds of satisfaction in a multivariate model. Furthermore, patients who required urethrolysis or had severe lower-urinary tract symptoms were significantly less likely to report satisfaction.
Increasing age, body mass index, and type of operation were associated with decreased odds of satisfaction.
American journal of obstetrics and gynecology 02/2011; 204(5):444.e1-6. · 3.28 Impact Factor
ABSTRACT: The purpose of this study was to compare continence rates after placement of rectus fascia or midurethral slings.
We performed a retrospective cohort study of 242 women who underwent rectus fascia (n = 79) or midurethral (n = 163) sling procedures to treat urinary incontinence. Outcome was based on responses to validated questionnaires and need for interim treatment for incontinence. Survival free of incontinence was estimated using the Kaplan-Meier method. Associations between patient factors and survival free of incontinence were evaluated by fitting Cox proportional hazards models.
Women with rectus fascia slings were more likely to report any leakage of urine (P = .04) and were 13 times more likely to require urethrolysis (P < .001) than patients with midurethral slings. Patient satisfaction was lower in the rectus fascia sling group compared with the midurethral sling group (P = .01).
Midurethral slings appear to be more effective than rectus fascia slings and are less likely to cause postoperative voiding complications.
American journal of obstetrics and gynecology 01/2009; 200(3):300.e1-6. · 3.28 Impact Factor