1012 A LONGITUDENAL EVALUATION OF SUBJECTIVE POSTOPERATIVE SYMPTOMS AND DISSATISFACTION IN WOMEN CURED OF STRESS INCONTINENCE AFTER SLING SURGERY

INTRODUCTION AND OBJECTIVES: In an earlier analysis of 728 women at 12 months after sling surgery, we determined that recurrent or persistent stress incontinence (SUI) accounted for only 25% of failures. However, of those dry from SUI, 28% had other subjective complaints, such as emptying difficulty and urge incontinence (UUI). Our goal was to re-evaluate the changes in postoperative symptoms in those women who were dry from SUI 2 years later. METHODS: Women who underwent sling surgery since 2002 at our institution were retrospectively identified. Preand postoperative assessment in all women included pelvic exam, cough-stress test (CST), SEAPI classification (SUI, Emptying, Anatomy (anterior vaginal wall descent), Protection (pad use), Inhibition (urge incontinence, UUI)), and Visual Analog Score (VAS, 1–10) measuring overall satisfaction. SUI cure was defined as SEAPI(S) 0 and a negative CST. Global cure was defined as subjective-SEAPI composite 0 and VAS 8. Demographics and postoperative details were abstracted from clinic charts. RESULTS: Of the original 153 women who were cured of SUI but failed globally, 136 (89%) completed 36 months of follow-up (f/u). Over time, overall improvement was seen in all SEAPI subscores but improvement was most prominent in emptying (46% to 41%) and UUI (71% to 64%). This appeared to be related to optimizing complementary therapies, such as sling revision and antimuscarinics. The prevalence of protection (21.7% to 21.4%) and anatomy (10% to 8.5%) remained stable with longer f/u. In the initial study, a VAS 8 was recorded in 23.5% women and 10 of these (6.5%) had a SEAPI composite 0. Reasons for dissatisfaction were posterior and apical prolapse, pelvic and abdominal pain, dyspareunia, and urgency. Of these 10 women, only 3 (2.5%) remained dissatisfied with longer f/u. With longer f/u, an additional 16 of 136 women (12%) achieved a global cure, while SUI recurred in 4 women. CONCLUSIONS: Post-operative SUI represents only a portion of those who fail sling surgery, while the prevalence of UUI and emptying difficulty may be significant in women who are cured of SUI. Optimizing complementary therapies may improve those factors contributing to global failure and increase rates of satisfaction with longer f/u. The longitudinal assessment of SEAPI or other multi-component scales provides valuable insight into the long-term outcomes after sling surgery.