Patient Reported Outcomes and Complications of Stress Incontinence Surgery: Effect of Patient Characteristics

Introduction and hypothesis: Multiple procedures exist to treat stress urinary incontinence. A database records outcomes and complications and ascertains how surgical and patient characteristics affect outcomes.

Methods: A retrospective cohort study of 31,901 women undergoing continence surgery from the British Society of Urogynaecologists Surgical Database (2008-2019), including 24,923 retropubic mesh-tapes, 4740 bulking agents, 538 fascial slings and 1700 colposuspension. Multivariable logistic regression was used for primary analyses to compare outcomes between treatments and secondary analysis to assess how different characteristics affect outcomes within treatment groups.

Results: Similar outcomes for patient reported global impression of improvement were observed following retropubic mesh-tapes, fascial slings and colposuspension (91%, 89%, 87%, respectively) compared to bulking agents (56.6%). For retropubic mesh-tapes, reduced odds of positive global impression of improvement was seen with increased age, body mass index, detrusor overactivity and intraoperative bladder injury. Odds of bladder injury increased with non-consultant grade operator and decreased with increasing BMI. For colposuspension, increased age led to decreased odds of success and increased odds of return to hospital and readmission. Repeat procedures led to decreased odds of success for retropubic tapes, bulking agents and colposuspension.

Conclusions: This large national database demonstrated that increased age, higher BMI, preoperative detrusor overactivity and bladder injury are associated with treatment failure. This information should be used in bespoke counselling to encourage personalised medical decision-making. Missing data is a limitation and would be improved with a mandatory database.