SLING OUTCOMES IN DIABETIC ANDNON-DIABETIC WOMEN: DO DIFFERENCES EXIST? A SECONDARY ANALYSIS OF THETOMUS DATA
D. E. CHUNG1, H. ABED2, H. BROWN 3, D. D. ANTOSH 4, S.OLIPHANT 5, C. L. GRIMES 6;
1Urology,Columbia Univ. Med. Ctr., New York, NY, 2Urology, Univ. ofMississippi Med. Ctr., Jackson, MS, 3OBGYN, Univ. ofWisconsin, Madison, WI, 4Houston Methodist Hosp., Houston,TX, 5OBGYN, Univ. of Arkansas, Little Rock, AR, 6OBGYN,Columbia Univ. Med. Ctr., New York, NY.
Introduction: There is evidencethat diabetes mellitus (DM) can lead to voiding dysfunction,including increased bladder capacity, impaired detrusorcontractility, and incomplete bladder emptying.
Objective:To examine the effect of DM on post-void residual (PVR) and lowerurinary tract symptoms after mid-urethral sling placement using datafrom the Trial of Midurethral slings (TOMUS).
Methods:Baseline demographics and symptom scores between 597 subjects withand without DM were compared. Differences in absolute and change inPVR at 2 and 6 weeks post-op were compared. Furthermore, subjectiveand objective treatment success was contrasted between groups.Chi-square, Fisher’s exact Student’s t-test, Mann-Whitney andlogistic regression were used.
Results: Demographicinformation between patients with and without DM were similar,including height, weight, and parity. Sling type and approach wassimilar between groups. In terms of symptoms before surgery, more DMpatients reported >3 UTIs prior to surgery (p=0.003), higherstress and urgency symptom scores (p=0.001), fear of not making it tothe bathroom in time due to urgency (78.9% vs. 65.6%, p=0.041) andhigher bother from urinary tract condition at baseline (p=0.022). Atbaseline patients with DM reported leaking urine fewer times per daythan patients without DM (p=0.053) but more patients with DM reportedleaking a large amount of urine per day than those without DM(p=0.012). Patients with DM also reported more leaking in their sleep(p=0.031), bedwetting (21.1 vs. 7.9%, p=0.000), and leakage for noobvious reason (p = 0.016) .There were no changes overall seen inabsolute or change in PVR at 2 and 6 weeks postop. No differenceswere seen in treatment success between groups. At 6 weeks followingsurgery, storage and voiding symptoms were similar. However thosewith DM were more likely to report leakage related to physicalactivity (24.5% vs. 14.8%, p=0.054). More patients with DM alsocomplained of pain when urinating and pelvic discomfort when standingor physically exerting (p=0.054). Postop patients who did not have DMwere more likely to report no leakage of urine(p=0.009).
Conclusions: Although there is evidence forvoiding dysfunction in patients with DM, few differences were seen inchanges in PVR, subjective, and objective success between subjectswith and without DM following mid-urethral sling placement. Atbaseline more patients with DM complained of nighttime leakage andreported more urgency. Post-op, subjects with DM were more likely toreport some leakage with physical activity and fewer DM subjectsreported being dry. Pain and pelvic discomfort were also more commonin those with DM. Our findings suggest that despite bladderdysfunction from DM, mid-urethral sling in diabetics remains a safeand effective surgical option for treatment of stress urinaryincontinence but subtle differences exist in treatmentoutcomes.
References: Richter HE, Albo ME, Zyczynski HM, etal. Retropubic versus transobturator midurethral slings for stressincontinence. NEJM, 2010; 362(22):2066-76. Ellenberg, M., Developmentof urinary bladder dysfunction in diabetes mellitus. Ann Intern Med,1980;92: p. 321.