Characteristics associated with treatment failure 1 year aft
Certain clinical and urodynamic variables are associated with treatment failure after midurethral sling in women with mixed urinary incontinence.

The aim was to evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence.

Four-hundred-three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) compared with midurethral sling alone for mixed incontinence with 1-year follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective or objective failure or both.

Subjective failure was defined as not meeting the minimal clinically important difference for improvement on the UDI (Urogenital Distress Inventory) total score (26.1 points). Objective failure was defined as not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for persistent urinary symptoms at 12 months postoperative.

- One hundred twelve of 379 women had overall treatment failure, with 56 of 379 undergoing additional treatment but only two needing intervention for stress incontinence.

- Previous overactive bladder (OAB) medication; detrusor overactivity on cystometrogram; and higher volume at first urge were associated with overall failure.

- Worse UDI-urgency scores were associated with failure, with an added interaction effect in the midurethral sling–alone group.

Women with more severe urgency symptoms at baseline may benefit from perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling. Overall, the need for additional urinary treatment was low and primarily for OAB.

Obstetrics & Gynecology
Source: https://journals.lww.com/greenjournal/Abstract/2021/08000/Characteristics_Associated_With_Treatment_Failure.6.aspx
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