Stress urinary incontinence (SUI)  is common and affects approximately one third of women.[1, 2] Tension-free Vaginal Tape (TVT), Autologous fascial sling and Burch colposuspension are surgical procedures recommended for the management of stress incontinence.[1] Some of the common complications of all three procedures include voiding dysfunction and overactive bladder symptoms.[2] The effect of SUI surgery on overactive bladder symptoms with or without incontinence is poorly understood and may be due to persistence of symptoms postoperatively or can occur de novo after surgery. [3] This can have a negative impact on patients’ perception of success of surgery and quality of life. 

The aim of this study is to assess the impact of different stress incontinence surgeries on bladder and voiding function in women.

This is a retrospective study. 90 women who had undergone surgery for stress incontinence in a tertiary centre in the UK were selected, providing data for 30 patients within each surgical cohort. Completed validated pelvic floor questionnaires: Electronic Personal Assessment Questionnaires (ePAQ), were used to evaluate pre-operative and post-operative bladder function at 3-12 months within each cohort. Sixty questions comprising the urinary function dimension were analysed according to the 5 ePAQ domains for bladder function – Pain and Sensation, Voiding, Overactive Bladder, Stress Incontinence and Quality of life. The domain scores and impact factor were calculated. The paired T-test was used to analyse a change in domain scores post-operatively. The one way ANOVA was used to compare results from the three different procedures.

The mean age of women in the study was 50.9 years. All patients were assessed withing 3-12 months after surgery (TVT M = 3, Colposuspension and Autologous slings M = 9)

Analysis of the data using paired T-test demonstrated an improvement in the impact of urinary function on quality of life postoperatively. There was no significant difference noted in pain and sensation symptoms postoperatively within either cohort. Overactive bladder symptoms were noted to be significantly improved following TVT and colposuspension procedures (p = <0.001), but the change was not statistically significant in the fascial sling cohort (p = 0.051). However, symptoms of voiding difficulty, reduced urinary stream and need for digitation to assist voiding, improved following fascial sling surgery (p = 0.03), and showed a degree of improvement following TVT and colposuspension (p = 0.47, 0.1 respectively). 

An analysis of variance (Anova) was used to determine if there was a significant difference between the three incontinence procedures within the urinary function domains. In the overactive bladder domain, there was a significant difference in symptoms noted based on the type of SUI surgery F (2,87) p = 0.015. The type of surgery did not however, appear to have a significant difference in quality of life, F (2,90) p = 0.15.

This study shows that all three stress urinary incontinence procedures have a significant impact on stress incontinence and quality of life. The type of surgery can have a variable impact on overactive bladder symptoms, with TVT and colposuspension procedures demonstrating significant improvement in symptoms postoperatively. This can aid clinicians in effective counselling of patients considering surgical management of stress incontinence. Further research using a larger sample size and review of long-term outcomes is needed to analyse this further.

NICE (2019) Surgery for stress urinary incontinence - Patient decision aid. Available at: https://www.nice.org.uk/guidance/ng123/resources/surgery-for-stress-urinary-incontinence-patient-decision-aid-pdf-6725286110.
Krishnaswamy PH, Tyagi V, Guerrero KL. Non-mesh surgery for stress urinary incontinence. The Obstetrician & Gynaecologist 2021; 23:213–19. https://doi.org/10.1111/tog.12742.
Zyczynski HM, Albo ME, Goldman HB et al; Urinary Incontinence Treatment Network. Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women. Obstet Gynecol. 2015 Aug;126(2):423-430. doi: 10.1097/AOG.0000000000000929. PMID: 26241434; PMCID: PMC4526119.