Tension-free vaginal tape procedure for the treatment of mixed urinary incontinence: significance of maximal urethral closure pressure.

PURPOSE: We investigated factors predicting persistent urge incontinence after the tension-free vaginal tape procedure in patients with mixed urinary incontinence.

MATERIALS AND METHODS: Between March 1999 and May 2003 female patients with complaints of urinary incontinence were evaluated according to our protocol. After the tension-free vaginal tape procedure patients were followed at 1, 6 and 12 months, and yearly thereafter. A total of 274 women (stress urinary incontinence in 201 and mixed urinary incontinence in 73) with followup at least greater than 6 months were included in the study. The cure of stress induced incontinence after the procedure was defined as an absent subjective complaint of leakage and objective leakage on stress testing. All other cases were considered failures.

RESULTS: There was no significant difference in the cure rate for stress induced incontinence between patients with stress and mixed urinary incontinence. However, 12 of 73 patients (16.4%) with mixed urinary incontinence had persistent urge incontinence. Thus, the overall cure rate was significantly higher in the stress incontinence group than in the mixed incontinence group (95.5% vs 78.1%, p <0.001). On multivariate analysis maximal urethral closure pressure was associated with a 0.9-fold risk of persistent urge incontinence after the procedure in patients with mixed urinary incontinence (OR 0.94, 95% CI 0.88 to 0.99, p = 0.030).

CONCLUSIONS: Our findings suggest that low maximal urethral closure pressure may be associated with persistent urge incontinence after the tension-free vaginal tape procedure in patients with mixed urinary incontinence.