Resolution of urge symptoms following sling cystourethropexy

Christopher G Schrepferman; Tomas L Griebling; Ingrid E Nygaard; Karl J Kreder

doi:10.1016/S0022-5347(05)67044-9

Persistence of urinary urge symptoms in women after pubovaginal sling cystourethropexy is a distressing problem. We assess the ability of preoperative video urodynamics to identify patients in whom urinary urge symptoms failed to resolve postoperatively. Materials and Methods: The records of 84 consecutive women who had undergone pubovaginal sling cystourethropexy were reviewed. Preoperative video urodynamics revealed stress urinary incontinence in all cases and concomitant detrusor instability in some. Cases of motor urge, defined as urge symptoms plus detrusor instability, were divided into low and high pressure categories. Patients with urge symptoms but no demonstrable detrusor instability on video urodynamics were diagnosed with sensory urge. Postoperatively complete urge resolution was defined as total absence of symptoms without pharmacological therapy. Mean followup was 26.7 months (range 2 to 62). Results: Of the 84 patients 41 with motor urge and 28 with sensory urge had preoperative urge symptoms. Complete resolution or improvement in urge symptoms occurred in 24 (58.5%) and 7 (17.1%) of the motor urge, and 11 (39.3%) and 9 (32.1%) of sensory urge cases, respectively. Of the 41 patients with motor urge 23 had low pressure instability, which completely resolved in 21 (91.3%) and improved in 2 (8.7%). Of the 18 remaining patients with high pressure motor urge only 5 (27.8%) had complete resolution of urge and 5 (27.8%) had improvement. Conclusions: Our results suggest that patients with low pressure motor urge are significantly more likely to experience resolution of urinary urge symptoms after pubovaginal sling cystourethropexy than those with high pressure motor urge or sensory urge. Urinary urgency is a troublesome and complex symptom that can complicate the diagnosis and treatment of women with stress urinary incontinence. For many patients with mixed incontinence the urge component is more bothersome and more likely to reduce quality of life. Despite this fact, first line intervention is frequently directed towards the incompetent bladder neck using surgical and nonsurgical approaches. A large proportion of women experience complete resolution or improvement of urge symptoms following anti-incontinence procedures. However, some women, experience no change or even worsened urgency. Persistent urgency and/or detrusor instability following anti-incontinence surgery reduces patient satisfaction and overall continence in most series. 1–7 In addition, patients who experience persistent or worsening urgency postoperatively often need further urological evaluation, particularly to rule out iatrogenic urinary obstruction. To date, published series designed to identify risk factors for persistent postoperative urgency have been contradictory. We examine the ability of preoperative video urodynamics to predict the likelihood of urinary urgency resolution following sling cystourethropexy

Resolution of urge symptoms following sling cystourethropexy

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