Surgical results in women with detrusor underactivity and stress urinary incontinence undergoing suburethral sling procedure-Predictive factors for successful outcome

Objectives To elucidate the treatment results and predictors for successful outcome in women with detrusor underactivity (DU) and stress urinary incontinence (SUI) undergoing suburethral sling procedure. Methods Medical records of women with coexistent SUI and DU treated with a suburethral sling were retrospectively reviewed and we analyzed the association between treatment outcome and baseline demographics including etiology of DU and urodynamic variables. Patients who were dry and could urinate spontaneously were considered successful. Treatment failure was considered in those who were dry but needing clean intermittent catheterization (CIC) and patients who were still wet. Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) scores were used to assess the impact of surgery on the quality of life. Results Among 71 patients, a successful outcome was noted in 39 (55%), failed outcome with CIC in 15 (21%), and totally treatment failure in 17 (24%). Treatment outcome did not differ among the etiology subgroups. Overall, UDI-6 and IIQ-7 scores significantly improved after surgery. Multivariable logistic regression analysis revealed that the IIQ-7 and maximum flow rate (Qmax) were two independent predictors for improvement after surgery. An IIQ-7 score <= 6, and Qmax >= 6 mL/s can predict improvement by receiver operating characteristic analysis. Qmax <= 6 mL/s can predict needing CIC after surgery. Conclusions For women with SUI and coexistent DU who underwent suburethral sling procedure, low IIQ-7 (<= 6) scores and higher Qmax (>= 6 mL/s) are predictors for improvement of surgical outcome. A Qmax of <6 mL/s was the only predictor for CIC after surgery.