DETERMINANTS OF FAILURE AFTER SLING SURGERY FOR FEMALE STRESS URINARY INCONTINENCE

Results: Of 728 women, 177 (24.3%) underwent autologous rectus fascia bladder neck slings, 259 (35.6%) underwent porcine dermis bladder neck slings, and 292 (40.1%) underwent polypropylene midurethral slings. The mean follow-up period for the entire cohort was 42 months. The “SUI cure” rate was 75.4% and “global cure” rate was 54.9% for the entire cohort. Of the 153 women (21%) who achieved SUI cure but not global cure, 143 (93.5%) had a SEAPI subjective composite score > 0. The reasons for failure included: emptying (43.1%), anatomy or bladder neck descent (9.2%), pad use (20.3%), and inhibition / urge incontinence (66%). A VAS < 8 was recorded in 36 (23.5%) women and 10 of these women (6.5%) failed for reasons not included in SEAPI (e.g. posterior and apical prolapse, pelvic and abdominal pain, dyspareunia, and urgency without incontinence). Despite women undergoing 3 different sling procedures differing in some demographic, urodynamic, and perioperative criteria, reasons for failure were not statistically different between sling types. A statistically significant improvement in all QOL indices was seen in “SUI cure” and failure groups, as well as “global cure” and failure groups. Interpretation of results: Although the populations of women undergoing surgery with different sling materials differed from one another, the rate of SUI resolution appears to be similar. Likewise, the incidence of postoperative urinary urge incontinence, voiding dysfunction, pad use, and bladder neck mobility are also similar. If these factors are considered, along with symptoms not accounted for by the SEAPI scale, then the true cure rate after sling surgery is more modest than originally quoted. Despite the different cure rates, women appear to have a significant improvement in their quality of life after sling surgery.