Natale F, et al. - Researchers in this work primarily assessed the long-term subjective and objective outcomes on continence and other urinary symptoms of a trans-obturator mid-urethral sling (TOT) procedure. Secondarily, they investigated its impact on quality of life (QoL) and assessed the factors influencing outcomes. As per findings, for patients with mixed urinary incontinence (MUI), TOT surgery can be performed following unsuccessful conservative therapy. Findings suggested menopause and age >60 as risk factors for failure. Consideration of the factors was recommended when counseling preoperatively.

Methods

• Researchers performed a single-centre prospective study on a consecutive series of 86 women who underwent TOT for MUI as defined by ICS/IUGA.
• Since the definition of MUI that they used is symptom-based, patients both with and without associated detrusor overactivity were included.
• Placement of Monarc Subfascial Hammocks was performed on all patients.
• They utilized McNemar chi-square test; the paired t-test; Fisher’s exact test.
• To assess age, parity, body mass index, menopausal status, preoperative detrusor over-activity, and detrusor pressure at maximum flow as possible factors for treatment failure, they used a logistic regression model and odds ratios.
• Multivariate analysis included only those that were statistically significant in the univariate analysis.

Results

• Researchers performed a mean follow-up of 59 months; SUI was cured objectively in 83.7% of patients and subjectively in 87.2%.
• Further anti-incontinence surgery was performed on 3 patients.
• In this study, the continence rates were 74.4% and 66.3% for urgency urinary incontinence (UUI) and SUI-UUI.
• They noticed patient-reported success rate of 87.2% (‘much better’ or ‘very much better’ on Patient Global Impression of Improvement scale).
• Statistically significant improvements in all domains except general health were noticed.
• The univariate analysis revealed no relevant risk factor for persistence of SUI.
• For persistence of UUI, median age >60 years and menopause were predictive.
• Predictors for persistence of overall incontinence included median and mean age >60 years.
• All variables lost their statistical significance in the multivariate model.