[Usefulness of urodynamics in the treatment of mixed urinary incontinence in women with suburethral slings].

Objective: The urodynamic results in suburethral slings (SS), are contradictory. We evaluate a series on patients with stress urinary incontinence (associated or not with bladder hyperactivity) that underwent suburethral slings (SS) operations.

Methods: 42 women (age 62±12 years) with urinary incontinence underwent suburethral slings (86% TOT, 12% TVT, 2% others), 36% of them with simultaneous pelvic organ prolapse correction. Medical history and a pre and postsurgery urodynamic studies (according to ICS instructions, except when specified) were performed.

Results: After surgery, the improvement of urinary incontinence was lower in patients with previous detrusor hyperactivity (DH) than without DH (60% vs 81 %), and the bladder capacity (BC) was lower (123±36 ml) in patients with previous mixed urinary incontinence (MUI) versus no MUI (241±83 ml) (p=0.004). The decrease of BC was higher with previous MUI (184±92 ml vs 123±36 ml) versus no MUI (240±91 ml vs 237±78 ml), and the DH was more frequent in previous MUI and DH. There was a significant decrease of maximum flow rate (Qmax) (p=0.000) (although without clinical manifestation), and post void residual urine (p=0.007). We demonstrated a significant increase (p=0.001) of mean urethral resistance (URA): 12±9 cm H2O versus 15±12 cm H2O (without reaching obstruction range), and an improvement of detrusor contractility (W80-20): (3±4 W/m2; vs 6±17 W/m2;).

Conclusion: We demonstrated worst results in MUI in patients with urinary incontinence undergoing SS. The urodynamic study gives a better prognosis reliability in the treatment of female urinary incontinence with SS.