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Worse long‐term surgical outcomes in elderly patients undergoing SPARC TM retropubic midurethral sling placement
Author(s) -
Kim Jason,
Lucioni Alvaro,
Govier Fred,
Kobashi Kathleen
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09880.x
Subject(s) - medicine , sling (weapon) , urinary incontinence , cohort , surgery , stress incontinence , cohort study , prospective cohort study , retrospective cohort study
Study Type – Diagnostic (case series) Level of Evidence 4 OBJECTIVE • The purpose of our study was to evaluate long‐term clinical outcomes following placement of a retropubic mid‐urethral sling in patients aged 70 and over and to compare outcomes with those of a younger cohort of patients. MATERIALS AND METHODS • Patients with stress urinary incontinence undergoing retropubic polypropylene sling (SPARC TM ) placement were entered into a prospective, institutional review board‐approved database. • Patients with at least 12 months follow‐up were sent postoperative questionnaires assessing outcomes. Results of these questionnaires were compared for patients aged 70 or older and those younger than 70 years. RESULTS • A total of 337 patients who underwent SPARC sling placement in an 8‐year period were identified. Of these, 290 patients had a minimum of 12 months follow‐up, and among these patients, 235 (81%) answered postoperative mailed questionnaires. Average follow‐up was 45.2 months. • Thirty‐seven patients were 70 or older, and 198 were younger than 70. The older group had significantly lower success (53.1% vs 83.6%) and dry (6.1% vs 35.3%) rates than the younger cohort. • Assessment of preoperative variables determined that the older cohort had significantly more vaginal deliveries and a higher percentage of patients who had undergone either hysterectomy, previous prolapse and/or incontinence surgery. • There was no significant difference in Valsalva leak‐point pressure, percentage of patients with intrinsic sphincteric deficiency or type 0 stress urinary incontinence between the two groups. CONCLUSIONS • Experience at our Institution shows that there are clearly lower success rates in older patients undergoing a SPARC sling as compared with a younger cohort of patients. • Parity, hysterectomy and previous pelvic organ prolapse/anti‐incontinence surgery may also play a role in the difference in outcomes.