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Master Thesis

Synthetic mid-urethral sling for the treatment of stress urinary incontinence in women with neurogenic lower urinary tract dysfunction: results of a retrospective multicentric study

Abstract : Background : Synthetic mid-urethral slings (sMUS) are the first-line surgical treatment for stress urinary incontinence (SUI) in women. The use of sMUS for the treatment of SUI in women with neurogenic lower urinary tract dysfunction (NLUTD) has been poorly assessed. Goals : To evaluate the results of sMUS for the treatment of SUI in women with NLUTD. Methods : A retrospective multicenter study was carried out in 3 tertiary referral centers in France. Women aged 18 years old or older, who had a sMUS implantation to treat SUI, who had a relevant neurological disorder diagnosed before the intervention were included. Patients with a follow-up period of less than one year, a surgical cure of pelvic organ prolapse performed at the time of sMUS implantation or who did not have a preoperative urodynamic study were excluded. The primary outcome was recurrence of SUI during follow-up. Secondary outcomes were answers to standardized questionnaires among patients who did not have reintervention for recurrence of SUI during follow-up: patient reported “dry” status, Patient Global Impression of Improvment (PGI-I ) and discomfort score related to urinary incontinence evaluated by question 3 of the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). The safety of the intervention was assessed by the occurrence of complications during follow-up, particularly de novo overactive bladder (OAB), urinary retention and tape exposure. Reintervention for complications or recurrence of SUI were also noted. Results: 115 patients were included. The median age was 53 years old (interquartile range 46-64 years old). The median follow-up duration was 53 months (interquartile range 46-64 months). At last follow-up, 57 patients (50%) presented with recurrence of SUI or had a reintervention for recurrence of SUI. In multivariate analysis, age below 50 years old, positive urethral support manoeuvres and multiparity were independent protective factors for SUI recurrence (HR: 0.3 95% CI (0.2-0.7) p <0.01; HR : 0.5 95% CI (0.3-0.98) p = 0.043 and HR: 0.5 95% CI (0.2-0.98) p = 0.043, respectively). The transobturator tape route was an independent risk factor for SUI recurrence (HR: 2.1 95% CI (1.1-4) p = 0.029). Among the patients who answered the standardized questionnaires, 53% considered themselves “dry” and 77.4% had a PGI-I less than or equal to 2. The median discomfort score related to urinary incontinence was 3 out of 10. Twenty-five of the 52 patients (48%) who had pure SUI preoperatively presented de novo HAV. 9 patients (8%) had a tape exposure. Sixteen of the 69 patients (23%) who were on spontaneous voiding presented with urinary retention, of which 7 had reintervention and 2 required definitive intermittent catheterization. Thirty-six patients (31.3%) had one or more reintervention during follow-up. Conclusion: sMUS is an option for the treatment of SUI in women with NLUTD. The continence rate is acceptable and patient satisfaction is high. However, patients should be informed of the risk of complications and reoperation.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03468622
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Tuesday, December 7, 2021 - 11:29:48 AM
Last modification on : Saturday, January 1, 2022 - 3:33:23 AM

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Clément Sarrazin. Synthetic mid-urethral sling for the treatment of stress urinary incontinence in women with neurogenic lower urinary tract dysfunction: results of a retrospective multicentric study. Human health and pathology. 2021. ⟨dumas-03468622⟩

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