SUI Outcomes After Sling Placement Unaffected By Age

A woman's age may not matter with midurethral sling surgery.
A woman's age may not matter with midurethral sling surgery.

BARCELONA—Older and younger women have similar stress urinary incontinence (SUI) outcomes after primary midurethral sling (MUS) placement, according to study findings reported at the 43rd Annual Meeting of the International Continence Society.

The results, however, also show that older patients are less likely to perceive that that their incontinence has improved with MUS than their younger counterparts.

“We believe these results have clinical relevance as they will enable physicians to enhance age-related patient counseling, especially regarding post-intervention expectations,” said David R. Ellington, MD, Fellow/Instructor in the Division of Urogynecology and Pelvic Reconstructive Surgery at the University of Alabama School of Medicine at Birmingham. “Many women worry that they may develop new lower urinary tract symptoms after MUS placement, and our study demonstrated that new-onset UUI and resolution of symptoms of this form of incontinence are similar for both age groups.”

The researchers reviewed results in 696 women who underwent primary MUS at their institution over a recent four-year period.

SUI affects about one third of all women, and the likelihood of developing the condition increases with age, Dr. Ellington noted.  The number of women aged 70 years and older is increasing, and thus it is thought that the number of women who seek medical care for lower urinary tract conditions in this age group will also increase.

Even so, limited reliable data are available about outcomes in older women undergoing MUS compared with younger women, he said. Midurethral sling surgery is the current gold standard for SUI treatment after conservative measures have failed, with overall success rates ranging from 77% to 90% depending on the definition of success.

The primary outcome of the present study was SUI symptoms defined as either “moderately” or “quite a bit” responses to at least one of the two SUI questions on the Pelvic Floor Distress Inventory (PFDI-20).  The PFDI-20 is both a symptom inventory and a measure of the extent of bother and distress caused by pelvic floor symptoms and is a shortened version of the original Pelvic Floor Distress Inventory.

The investigators documented SUI failure rates of 27.4% in women younger than 70 and 33.1% in women aged 70 and older. Multivariate analysis demonstrated no significant difference in SUI failure rates between the two age groups.

A significantly larger proportion of older women had baseline urgency urinary incontinence (UUI) symptoms (64.1% versus 51.4%), but the two groups did not differ in terms of rates of resolution of UUI symptoms (34.2% and 29.6%) or de novo UUI symptoms after primary MUS (4.3% and 7.5%).

Only 56.6% of older women older women reported having the impression that their SUI improved as shown on the Patient Global Impression of Improvement (PGI-I) index after their procedure compared with 67.7% of younger women.

Although the study's retrospective design may represent a potential limitation, Dr. Ellington emphasized that the results are bolstered by the use of a large cohort of women as well as robust pre- and post-surgical data collection.

He added that his group may eventually compare voiding function between older and younger patients since voiding function may have an impact on PGI-I scores.

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