The purpose of this study was to look at the factors that contributed to treatment failure one year after using a midurethral sling in women with mixed urine incontinence. Four hundred three women with 1-year follow-up data from a randomised trial comparing midurethral sling plus behavioural and pelvic floor muscle treatment to midurethral sling alone for mixed incontinence were eligible for this planned secondary analysis. Overall treatment failure was characterised as satisfying subjective or objective failure criteria, or both. Subjective failure was defined as failing to reach the lowest clinically significant difference for improvement in the UDI total score. At 12 months postoperative, objective failure was defined as not attaining 70% improvement in mean incontinence occurrences of any kind per day or having had any further therapy for persisting urine symptoms. Treatment failure logistic regression models were developed. Based on bivariate comparisons, independent factors included location and treatment group, as well as clinical and demographic characteristics. The effects of treatment group interaction were investigated. Previous OAB treatment, detrusor overactivity on a cystometrogram, and a greater volume at initial urge were all linked to overall failure. Worse UDI-urgency ratings were linked with failure, with an additional interaction effect in the midurethral sling–alone group.
In women with mixed urine incontinence, several clinical and urodynamic characteristics are linked with treatment failure following midurethral sling. Women who have more acute urgency feelings at the start of the procedure may benefit from perioperative behavioural and pelvic floor muscle treatment coupled with a midurethral sling. Overall, there was a limited need for further urinary therapy, which was largely for OAB.
