Hypothesis / aims of study
Several kinds of storage symptoms, including frequency, urgency, and urgency urinary incontinence (UUI), can accompany the SUI. The SUI surgery can improve OAB symptoms. De novo urgency and UUI are observed in some patients with no previous evidence of storage symptoms after anti-incontinence surgery.The aim of this study was to evaluate the prevalence and the risk factors of de novo urgency and UUI after TOT
Study design, materials and methods
It was a prospective study on female patients with SUI underwent TOT from 2002 to 2015.Exclusion criteria were as follows: women with pure SUI, diabetes or neurologic disease; POP ≥ stage II.Preoperative evaluation includes medical history, objective examination, dynamic urologic ultrasonography, urodynamic examination,according to ICS criteria .Follow-up visits are performed at 1 month,3,6,12 months after surgery and annually , with the same preoperative evaluations except for urodynamic examination which is performed at 6 months after surgery.Stress urinary incontinence was defined according to ICS standardization and classified
according to the Ingelmann-Sundberg scale.Urinary symptoms were evaluated using the standardized questionnaire UDI6.TOT surgery was performed by an expert surgeon using the out-in transobturator technique originally described by Delorm.Objective cure for SUI was defined as the absence of urine leakage during the stress test. Subjective cure was defined by a “no answer” to question 3 of the UDI-6 questionnaire.The study was approved by the Ethics Committee of our institution. All patients signed informed
consent
Results
A total of 180 pts (58.9±11 y) were included in the study. The follow up was 155±85 m Overall, 70 patients had pure SUI, 110 had concurrent OAB dry. There was no significant difference in demographics between the pure SUI and the SUI with urgency groups. In the pure SUI group the success rate was 86%, de novo urgency developed in 22 (31.4%) pts. The severity of urgency was
tolerable in 16 pts; only 6 pts required medical treatment. Six patients developed urgency 4 years after surgery; six immediately after the surgical procedure; ten pts between 6 months and 2 years. Six pts with early de novo urgency had not voiding symptoms.In the SUI with urgency group, the success rate was 81%, de novo UUI developed in 23 patients (20.9%), of these 16% after 4 years.Sixtyeight pts (62.3%) had resolved urgency. In those with persistent urgency (38.1%), the subjective severity of urgency was improved in 27, the same in 10, and aggravated in 5. Table 1showed that the BMI≥25,age > 60 years, DO were risk factors for de novo urgency in patients with pure SUI, and for de novo UUI in patients with SUI and OAB dry.
Interpretation of results
sults are in agreement with the literature. In literature the reported incidence of de novo OAB ranged from 1.7% to 42%.and the rate increased after surgery to 14.9% at 10 years follow-up. A possible explanation for the late occurrence of OAB symptoms might be formation of fibrosis around the sling. Obviously, these symptoms could also be the result of ageing, since the prevalence of OAB increases with age.