DOES ANTI-INCONTINENCE SURGERYAFFECT URINARY INCONTINENCE-SPECIFIC QUALITY OF LIFE IN PROLAPSEPATIENTS AFTER TRANS-VAGINAL MESH SURGERY?
M. KINJO1, Y.YOSHIMURA 2, T. OKEGAWA 1, K. NUTAHARA 1;
1Urology, Kyorin Univ. Sch. of Med., Tokyo, Japan,2Yotsuya Med. Cube, Tokyo, Japan.
Introduction: About 40-50% ofpelvic organ prolapse (POP) patients report stress urinaryincontinence (SUI). Such patients are at high risk of persistent SUIsymptoms after undergoing surgery to repair their POP. Also, 20-30%of POP patients without symptomatic SUI before POP repair develop denovo SUI after prolapse surgery. On the other hand, about 30% of POPpatients with symptomatic SUI before prolapse repair are cured oftheir SUI after prolapse repair alone. It is unclear whetheranti-incontinence procedures are indicated for POP patients whorequire surgery. Both POP and SUI affect patients’ quality of life(QOL); thus, we need to evaluate not only surgical outcomes, but alsopatients’ QOL and satisfaction.
Objective: The aim ofthis study was to assess the change in SUI status and urinaryincontinence-specific QOL after transvaginal mesh (TVM) surgery withor without a midurethral sling (MUS) procedure. The patients decidedwhether they wanted to undergo an MUS procedure.
Methods: Atotal of 144 symptomatic POP patients who underwent TVM surgery wereenrolled in this study. All patients were subjected to a diagnosticwork-up involving medical history taking, a physical examination(including a transvaginal examination), and laboratory tests. POP wasstaged using the POP quantification system. The patients were dividedin three groups based on their SUI status and whether they underwentan MUS procedure: (1) the patients with symptomatic or occult SUI whounderwent an MUS procedure (n=54); (2) the patients with symptomaticor occult SUI who did not under go an MUS procedure (n=53); and (3)the patients with no symptomatic or occult SUI who did not undergo anMUS procedure (n=37). The International Consultation of IncontinenceQuestionnaire-Short Form (ICIQ-SF) was used to evaluate the patients’incontinence symptoms and urinary incontinence-specific QOL, and theKing’s Health Questionnaire (KHQ) was used to assess theirincontinence-specific QOL. Assessments were performed before surgeryand at 12 months after surgery. All subjects provided informedconsent before entering the study. The Wilcoxon signed-rank test andChi-squared test were used for the statistical analyses and p-valuesof <0.05 were considered statistically significant.
Results:At 12 months after TVM surgery, the SUI cure rate was 94.4% (51 outof 54) in the SUI with MUS group and 34.1% (17 out of 53) in the SUIwithout MUS group (p<0.05). Three patients (5.7%) subsequentlyrequired MUS procedures in the SUI without MUS group, but this wasnot the case for any of the patients in the SUI with MUS group(p<0.05). De novo SUI developed in 25% (8 out of 32) of the no SUIwithout MUS group, but these patients did not subsequently requireMUS procedures. Significant improvements in the median total ICIQ-SFscore were seen in the SUI with MUS group (6.0→0) (p<0.05) andSUI without MUS group (5.0→4.0) (p<0.05) after the TVM surgery.However, in the no SUI without MUS group the median total ICIQ-SFscore was significantly worse at 12 months after the TVM surgery(0→3.0) (p<0.05). In the SUI with MUS group and SUI without MUSgroup, all KHQ domains except for personal relationships weresignificantly improved after the TVM surgery (p<0.05). In the noSUI without MUS group, the scores for general health perceptions andthe incontinence impact domain improved significantly after the TVMsurgery (p<0.05).
Conclusions: Patients with POP and SUIwere less likely to have SUI if they underwent TVM surgery combinedwith MUS compared with TVM surgery alone. However, of the patientswho underwent TVM alone only three (5.7%) required additional MUSprocedures for SUI. After TVM surgery, urinary incontinence-specificQOL improved irrespective of whether MUS surgery was performed. Thepatients decided whether to undergo MUS at the time of POP repair,and their incontinence-specific QOL improved despite the highpersistence rate of SUI. Simultaneous MUS surgery is not indicatedfor all POP patients who undergo TVM surgery. Instead, MUS surgeryshould be selected based on the severity of the patient’s disease,and the patient should make the final decision after receivingsufficient information.
References: BJOG 2014 121(5):537-47