Urinary incontinence (UI) is common health problem in female population. UI has a negative impact on many aspects of patients’ quality of life, including their daily activities, personal relationships, and mental health. Many studies have demonstrated a relationship between depression and UI. About 20-40% in female UI patients reported the depressive symptoms. Based on the type of incontinence, some studies reported that the rate of depression was higher in urge UI (UUI) and mixed UI (MUI) patients than in stress UI (SUI). Moreover, some research showed treatment of UI improved not only UI symptoms but depression symptoms especially in UUI and MUI treated by pharmacological treatment. However, we have a few reports about influence on treatment for SUI surgery for depression and/or anxiety. Also, it is not clear whether surgical treatment for SUI will improve the mental state such as anxiety/depression especially in long term.
The aim of this study is to evaluate the efficacy of mid-urethral sling surgery against SUI and its effects　on anxiety and depression of SUI or SUI dominant MUI patients.

A total of 102 female SUI or SUI dominant MUI patients who underwent mid-urethral sling (MUS) surgery (retropubic or transobturator) and followed up for 12 months were retrospectively evaluated in this study. In order to examine the efficacy of the surgery on symptom for UI, overactive bladder (OAB), and anxiety and depression, the following tools were used to evaluate before surgery and 12 months after surgery: the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), Overactive Bladder Symptom Sore (OABSS, a validated tool for overactive bladder symptom in Japan), and the Hospital Anxiety and Depression Scale (HADS, a validated tool for detecting anxiety and depression in a non-psychiatric outpatient population). The Wilcoxon signed-rank test and McNemar test were used for the statistical analyses and p-values of <0.05 were considered statistically significant.

The patients’ median age, median body mass index, and median parity values were 59 (range: 38-82) years, 23 (range: 16.8-34.9) kg/m2, and 2 (range: 0-3), respectively, and 69 patients (67.6%) were postmenopausal. Eighty one patients (79.4%) were diagnosed as SUI and 21 patients (20.6%) were diagnosed as SUI dominant MUI. At the baseline, 22 patients (21.6%) had been diagnosed with clinical anxiety (HADS-Anxiety score: ≥8), and 18 patients (17.6%) had been diagnosed with clinical depression (HADS-Depression score: ≥8). There were no difference in median HADS-A score and median HADS-D score between SUI group and SUI dominant MUI group (median HADS-A score: SUI group were 3.0, MUI group were 4.0, p=0.46) (median HADS-D score: SUI group were 3.0, MUI group were 4.5, p=0.47). Three patients prescribed antidepressants for insomnia, however they were not diagnosed as depression or consulting psychiatrist.
At 12 months postoperatively, the subjects’ median ICIQ-SF total score, median OABSS total score and median HADS-Depression score were significantly improved compared with their baseline values (ICIQ-SF: 12.0→0.0, OABSS: 2.0→1.0, HADS-Depression: 3.5→2.0) (p<0.05), but the median HADS-Anxiety score were not changed significantly (3.5→3.0) (p=0.18). Also, the rate of diagnosed as clinical depression was significantly decreased from 17.6% to 7.7% (p=0.03), but not in the rate of clinical anxiety (from 21.6% to 15.6%) (p=0.28).

This study demonstrated that MUS surgery significantly improved UI, overactive bladder (OAB) symptoms and depression, but not anxiety, in SUI or SUI dominant MUI patients. It is assumed that the improvement of the patients’ UI symptom helped to relieve their depression. However, it suggested that patients’ fear for recurrence of UI affected the HADS Anxiety score.

To the best of our knowledge, this is the first report to evaluate the effects of MUS on the UI, OAB symptoms and mental state of Japanese female SUI or SUI dominant MUI patients for relatively long term. MUS for SUI or SUI dominant MUI patients seemed to improve not only UI symptoms but also depression symptoms.