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Recordings

General Session II

Stress Urinary Incontinence Procedure Outcomes in Women <40 Years Old

Wednesday, October 23, 2024
3:45 PM – 3:49 PM EDT
Location: Liberty Ballroom (Meeting Level 4)
Live Streamed
Outcomes at 8 Week Postoperative Visit
Table 1.docx
Complications
Table 2.docx
Objectives: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of many women, but treatment outcomes in younger patients are sparsely reported. We sought to evaluate SUI procedure outcomes in patients < 40 years old.

Methods: We conducted a multicenter retrospective cohort study of female patients < 40 years old who underwent a primary SUI procedure between January 1, 2020 and July 1, 2023. This study was supported by the Fellows Pelvic Research Network (FPRN). We compared outcomes and complication rates of midurethral slings to periurethral bulking with polyacrylamide hydrogel (PAHG). Data was extracted by manual chart review and analyzed using descriptive statistics.

Results: Fifteen study sites were included, with individual IRB approvals obtained at each site. 317 women were identified who underwent a primary SUI procedure during the study period; 37 underwent periurethral bulking with PAHG and 280 underwent sling (262 (93%) retropubic, 6 (2.1%) transobturator, 3 (1.1%) single incision, and 10 (3.6%) fascial). Baseline demographics were similar between groups. Outcomes were extracted from information at the follow up visit closest to 8 weeks from the index procedure. Cure rate, defined as subjective report of no SUI, >90% improvement, or UDI-6 question 3 score of 0, was 56% (n=15) for PAHG and 87% (n=226) for slings (p < 0.0001); improvement rates, defined as subjective improvement that did not meet criteria of “cure” was 30% (n=8) for PAHG and 11% (n=29) for slings (0.006); report of no change in symptoms was 15% (n=4) for PAHG and 1.9% (n=5) for slings (p= 0.006) (Table 1). No subjects in either group reported worsening of their SUI. Complication rates were low between the groups (Table 2), but higher blood loss was noted with slings (30ml (IQR 15-50)) versus PAHG (0ml (IQR 0-1mL)) (p < 0.0001). Patient report of SUI recurrence throughout the study period was 47% (n=17) in the PAHG group compared to 12% (n=32) in the sling group (p < 0.0001), with a mean follow up duration of 31 weeks (+/-26 weeks). After SUI intervention, 11% (n=3) of PAHG and 16% (n=43) of sling (p=0.59) patients noted subjective improvement in OAB symptoms. De novo OAB symptoms were rare in both groups, with 3.7% (n=1) for PAHG and 1.5% (n=4) for slings (p=0.39). 12 women (4.3%) who underwent a sling procedure had a subsequent pregnancy after their surgery. No women in the PAHG group had a subsequent pregnancy.

Conclusions: Women who received periurethral bulking with PAHG for treatment of SUI had lower cure rates of their SUI compared to those who received a sling. The improvement with periurethral bulking with a single injection of PAHG was higher than that reported in prior studies that included older subjects.
Disclosure(s):
Ashley M. Huber, MD: No financial relationships to disclose
Hoa T. Nguyen, MD: No financial relationships to disclose
Nicole A. Meckes, MD: No financial relationships to disclose
Sujatha Narayanamoorthy, MD: No financial relationships to disclose
Lauren Tholemeier, MD: No financial relationships to disclose
Ravi D. Patel, MD: No financial relationships to disclose
Gabriella M. Rustia, MD: No financial relationships to disclose
Margot Le Neveu, MD: No financial relationships to disclose
Madeline Coulter, MD: No financial relationships to disclose
Zachary S. Selzler, MD: No financial relationships to disclose
Jared M. Floch, DO, MS: No financial relationships to disclose
K. Marie Douglass, MD/MPH: No financial relationships to disclose
Trieu H. Do, MD: No financial relationships to disclose
Alexander DelVlahos, MD: No financial relationships to disclose
Nancy Ringel, MD, MS: No financial relationships to disclose

    Presenting Author(s)

  • Ashley M. Huber, MD (she/her/hers)

    Fellow Urogynecology
    Yale University
    New Haven, Connecticut, United States

    Disclosure(s): No financial relationships to disclose

    • Co-Author(s)

  • Hoa T. Nguyen, MD (she/her/hers)

    Urogynecology and Reconstructive Pelvic Surgery Fellow
    Northwestern
    Chicago, Illinois, United States

    Disclosure(s): No financial relationships to disclose

  • Nicole A. Meckes, MD (she/her/hers)

    Urogynecology and Reconstructive Pelvic Surgery Fellow Physician
    UPMC Magee-Womens Hospital
    Pittsburgh, Pennsylvania, United States

    Disclosure(s): No financial relationships to disclose

  • Sujatha Narayanamoorthy, MD (she/her/hers)

    Fellow, Division of Urogynecology and Reconstructive Pelvic Surgery
    Mayo Clinic
    Rochester, Minnesota, United States

    Disclosure(s): No financial relationships to disclose

  • Lauren Tholemeier, MD

    Fellow Physician
    University of North Carolina
    Chapel Hill, North Carolina, United States

    Disclosure(s): No financial relationships to disclose

  • RP

    Ravi D. Patel, MD (he/him/his)

    Urogynecology Fellow
    Mount Auburn Hospital/Beth Israel Deaconess Medical Center
    Somerville, Massachusetts, United States

    Disclosure(s): No financial relationships to disclose

  • Gabriella M. Rustia, MD

    Fellow
    University Hospitals/MetroHealth Hospitals
    Westlake, Ohio, United States

    Disclosure(s): No financial relationships to disclose

  • Margot Le Neveu, MD (she/her/hers)

    Fellow
    University Hospitals Cleveland Medical Center/MetroHealth
    Cleveland, Ohio, United States

    Disclosure(s): No financial relationships to disclose

  • MC

    Madeline Coulter, MD

    URPS Fellow
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    Disclosure(s): No financial relationships to disclose

  • ZS

    Zachary S. Selzler, MD

    Urogynecology Fellow
    LSU Health New Orleans
    New Orleans, Louisiana, United States

    Disclosure(s): No financial relationships to disclose

  • Jared M. Floch, DO, MS (he/him/his)

    Urogynecology and Reconstructive Pelvic Surgery Fellow
    University of Rochester Medical Center
    Rochester, New York, United States

    Disclosure(s): No financial relationships to disclose

  • K. Marie Douglass, MD/MPH (she/her/hers)

    Fellow
    Harbor-UCLA Medical Center
    Los Angeles, California, United States

    Disclosure(s): No financial relationships to disclose

  • Trieu H. Do, MD (he/him/his)

    Fellow Physician
    University of Texas Medical Branch
    Houston, Texas, United States

    Disclosure(s): No financial relationships to disclose

  • AD

    Alexander DelVlahos, MD (he/him/his)

    Fellow
    Montefiore Medical Center/Albert Einstein CoM
    New York, New York, United States

    Disclosure(s): No financial relationships to disclose

  • Nancy Ringel, MD, MS (she/her/hers)

    Assistant Professor
    Yale School of Medicine
    New Haven, Connecticut, United States

    Disclosure(s): No financial relationships to disclose