Urinary incontinence (UI) symptoms are more prevalent and severe in older women. Knowledge regarding the impact of native tissue vaginal prolapse repair with concomitant midurethral sling on UI in older women is scarce. We hypothesize that older age increases risk of refractory UI symptoms after midurethral sling. This study aims to examine the impact of midurethral sling surgery on UI symptoms in women older than 70 years 12 months after undergoing native tissue vaginal repair with midurethral sling.

We performed a secondary data analysis of a randomized controlled trial comparing retropubic versus single-incision sling in women undergoing treatment of stress UI and native tissue vaginal repair. Women with stage II or greater pelvic organ prolapse and objectively confirmed stress UI undergoing native tissue vaginal repair and concomitant midurethral sling were included. UI symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI)-20.  Responses to question 16, 17, and 18 of the PFDI-20 were grouped into absent UI (answer = no, 0) and present UI (answer = yes, 1-4). Urgency UI was present with answer of yes to question 16. Stress UI was present with answer of yes to question 17. Chi-square and T-test (Mann Whitney U) examined the relationships between clinical characteristics and persistent UI at 12 months post surgery. Univariable and multivariable logistic regression analysis were performed examine these associations. A forced multivariable logistic regression that controlled for body mass index (BMI) and Charlson comorbidity index (CCI) evaluated the association between age and persistent UI symptoms.

Two-hundred, fifty-five women were included, 123 age<70 years, and 132 aged ≥70 years. Women ≥70 years had lower BMI (p= <0.001), worse prolapse stage, more occult stress UI (Table1). Any persistent UI was present in significantly more women ≥70 years (n=71, 60.2%) compared to 44 (40%) of women <70 years, p=0.002.  Persistent stress UI was not significantly impacted by age. However, urgency UI was more prevalent among women ≥70 years [n=57, 48.3%] at 12 months compared to 32 (29%) of women <70 years, p=0.003. Women ≥70 years had increased the odds of having any UI symptoms at 12 months, [OR 2.30, 95% CI (1.35,3.91), p=0.002], but this association lost significance in multivariable regression while BMI and CCI remained significant (Table 2).  However, age≥70 years had higher odds of having persistent urgency UI [OR 2.31 95% CI (1.34-3.99)], p=0.003; this independent association remained significant after adjusting for BMI, CCI, and colpocleisis procedure (95% CI 1.20-5.12), p=0.01.

Older age beyond 70 years is strongly associated with persistent urgency UI symptoms despite midurethral sling concomitant with native tissue prolapse repair.

While urgency UI may be reduced in 60% of women after midurethral sling performed concomitantly with native tissue prolapse surgery, women older than 70 years should be counseled that about their potential risk for persistent symptoms.