Outcomes and failure risks in mid-urethral sling insertion in elderly and old age with urodynamic stress incontinence
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ORIGINAL ARTICLE
Outcomes and failure risks in mid-urethral sling insertion in elderly and old age with urodynamic stress incontinence Tsia-Shu Lo 1,2,3
&
Nagashu Shailaja 4 & Yiap Loong Tan 5 & Ming-Ping Wu 6,7 & Sandy Chua 8 & Kwok Weng Roy 9
Received: 10 September 2019 / Accepted: 25 October 2019 # The International Urogynecological Association 2019
Abstract Introduction and hypothesis To study the surgical outcomes and risk factors for failure of three types of mid urethral slings(MUS) surgeries in elderly and old age women with urodynamic stress incontinence(USI). Methods Three different types of MUS surgeries [single incision sling(SIS), trans-obturator tape(TOT), retro-public mid-urethral sling-tension-free vagina tape (TVT)]were performed among three age groups of women (young 75 yr) with USI. They were followed up for 1 year. Results Complete postoperative data was available for 688 women. After 1 year, overall objective cure rate was 88.2% and subjective cure rate was 85.9%. Among the young, elderly, and old age women objective cure rates were 91.0%, 80.6%, 66.7% and subjective cure rates were 89.2%, 77.6%, 58.3% respectively. Urodynamic parameters demonstrated flow rate, higher post-void bladder residual, smaller cystometric capacity, and lower maximum urethral closure pressure were significantly lower among old and elderly group. Subjectively, urinary distress inventory-6 (UDI-6) and incontinence impact questionnaire-7(IIQ-7) improved significantly in all groups with significant changes from baseline only in older women. Intrinsic sphincter deficiency(ISD) was found to be significantly associated with failure in older women. Other preoperative comorbidities were equally distributed among all the three age groups. The operative time, perioperative complications, and length of hospital stay showed no difference between the study groups. Conclusions MUS surgery is safe for the young and aging patients with USI and demostrated significant improvement in its outcomes, but objective and subjective cure rates decreases with age. ISD was also found to be significantly associated with failure. Keywords Mid-urethral sling . Intrinsic sphincter deficiency . Urodynamic stress incontinence . Old age . Elderly
Introduction Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in older women. In older people, * Tsia-Shu Lo [email protected] 1
Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan 333, Republic of China
2
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung & Taipei, Medical Center, Keelung and Taipei, Taiwan, Republic of China
3
Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China
4
Department of Obstetrics and Gynaecology, Peoples Education Society Medical College and Research Centre, Kuppam, Andhra Pradesh, India
increased voiding frequency, nocturia, urgency, urge incontinence and p
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