Predictors of an improvement in the severity of concomitant urodynamic stress incontinence after transvaginal mesh surgery for pelvic organ prolapse

Background/purpose: Factors affecting the anti -incontinence efficacy of a tailored anterior transvaginal mesh (ATVM) surgery are undetermined. Thus, our aim was to investigate predic- tors for anti -incontinence efficacy of this ATVM surgery. Methods: Medical records of women with pelvic organ prolapse and concomitant evident or occult urodynamic stress incontinence, who underwent the ATVM surgery but without concom- itant anti -incontinence surgery, were reviewed. Results: A total of 134 women were reviewed, including those who underwent ATVM only (n = 45), ATVM and posterior transvaginal mesh surgery (n = 88), and ATVM with total vaginal hysterectomy (n = 1). Multivariable analysis revealed that stage of cystocele (coefficient = 56.4), functional profile length (cm, coefficient = 61.1) and the score of gen- eral health perceptions in the King?s Health Questionnaire (coefficient = -3.3) were indepen- dent predictors of the percentage change in pad weight from baseline. Seven (5.2%) women were found to have recurrent or persistent stress urinary incontinence, and 6 of the above 7 women underwent transobturator mid -urethral sling procedure. Free of further anti - incontinence surgery probabilities were 94.7% and 89.2% at 3 and 6 years after surgery, respec- tively. Functional profile length (hazard ratio = 2.61) was also identified as a predictor for further anti -incontinence surgery. Conclusion: Lesser degree of cystocele, shorter functional profile length and poorer general health perceptions were predictors of greater anti -incontinence effect after the tailored ATVM surgery. Besides, longer functional profile length was also a predictor for further anti-incontinence surgery after the ATVM surgery. Copyright (C) 2020, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).