Change in Overactive Bladder Symptoms after Surgery for Stress Urinary Incontinence in Women

Halina M. Zyczynski, Michael E. Albo, Howard B. Goldman, Clifford Y. Wai, Larry T. Sirls, Linda Brubaker, Peggy Norton, R. E. Varner, Maude Carmel, Hae Young Kim

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline. METHODS: This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data. RESULTS: Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery. CONCLUSION: Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement. LEVEL OF EVIDENCE: II

Original languageEnglish (US)
Pages (from-to)423-430
Number of pages8
JournalObstetrics and Gynecology
Volume126
Issue number2
DOIs
StatePublished - Aug 23 2015

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Overactive Urinary Bladder
Stress Urinary Incontinence
Urinary Incontinence
Suburethral Slings
Odds Ratio
Confidence Intervals
Equipment and Supplies
Urodynamics
Cholinergic Antagonists
Linear Models
Obesity

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Zyczynski, H. M., Albo, M. E., Goldman, H. B., Wai, C. Y., Sirls, L. T., Brubaker, L., ... Kim, H. Y. (2015). Change in Overactive Bladder Symptoms after Surgery for Stress Urinary Incontinence in Women. Obstetrics and Gynecology, 126(2), 423-430. https://doi.org/10.1097/AOG.0000000000000929

Change in Overactive Bladder Symptoms after Surgery for Stress Urinary Incontinence in Women. / Zyczynski, Halina M.; Albo, Michael E.; Goldman, Howard B.; Wai, Clifford Y.; Sirls, Larry T.; Brubaker, Linda; Norton, Peggy; Varner, R. E.; Carmel, Maude; Kim, Hae Young.

In: Obstetrics and Gynecology, Vol. 126, No. 2, 23.08.2015, p. 423-430.

Research output: Contribution to journalArticle

Zyczynski, HM, Albo, ME, Goldman, HB, Wai, CY, Sirls, LT, Brubaker, L, Norton, P, Varner, RE, Carmel, M & Kim, HY 2015, 'Change in Overactive Bladder Symptoms after Surgery for Stress Urinary Incontinence in Women', Obstetrics and Gynecology, vol. 126, no. 2, pp. 423-430. https://doi.org/10.1097/AOG.0000000000000929
Zyczynski, Halina M. ; Albo, Michael E. ; Goldman, Howard B. ; Wai, Clifford Y. ; Sirls, Larry T. ; Brubaker, Linda ; Norton, Peggy ; Varner, R. E. ; Carmel, Maude ; Kim, Hae Young. / Change in Overactive Bladder Symptoms after Surgery for Stress Urinary Incontinence in Women. In: Obstetrics and Gynecology. 2015 ; Vol. 126, No. 2. pp. 423-430.
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abstract = "OBJECTIVE: To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline. METHODS: This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70{\%} or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data. RESULTS: Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71{\%}) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5{\%} compared with 70.7{\%}, P.32; odds ratio [OR] 0.83, 95{\%} confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9{\%} compared with 56.6{\%}, P.01; OR 1.59, 95{\%} CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3{\%} of patients reported 70{\%} greater improvement in UI. This proportion declined to 36.5-54.1{\%} at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery. CONCLUSION: Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement. LEVEL OF EVIDENCE: II",
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AU - Sirls, Larry T.

AU - Brubaker, Linda

AU - Norton, Peggy

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N2 - OBJECTIVE: To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline. METHODS: This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data. RESULTS: Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery. CONCLUSION: Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement. LEVEL OF EVIDENCE: II

AB - OBJECTIVE: To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline. METHODS: This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data. RESULTS: Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery. CONCLUSION: Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement. LEVEL OF EVIDENCE: II

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