Worse long-term surgical outcomes in elderly patients undergoing SPARC TM retropubic midurethral sling placement

Jason Kim, Alvaro Lucioni, Fred Govier, Kathleen Kobashi

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

OBJECTIVE The purpose of our study was to evaluate long-term clinical outcomes following placement of a retropubic mid-urethral sling in patients aged 70 and over and to compare outcomes with those of a younger cohort of patients. MATERIALS AND METHODS Patients with stress urinary incontinence undergoing retropubic polypropylene sling (SPARCTM) placement were entered into a prospective, institutional review board-approved database. Patients with at least 12 months follow-up were sent postoperative questionnaires assessing outcomes. Results of these questionnaires were compared for patients aged 70 or older and those younger than 70 years. RESULTS A total of 337 patients who underwent SPARC sling placement in an 8-year period were identified. Of these, 290 patients had a minimum of 12 months follow-up, and among these patients, 235 (81%) answered postoperative mailed questionnaires. Average follow-up was 45.2 months. Thirty-seven patients were 70 or older, and 198 were younger than 70. The older group had significantly lower success (53.1% vs 83.6%) and dry (6.1% vs 35.3%) rates than the younger cohort. Assessment of preoperative variables determined that the older cohort had significantly more vaginal deliveries and a higher percentage of patients who had undergone either hysterectomy, previous prolapse and/or incontinence surgery. There was no significant difference in Valsalva leak-point pressure, percentage of patients with intrinsic sphincteric deficiency or type 0 stress urinary incontinence between the two groups. CONCLUSIONS Experience at our Institution shows that there are clearly lower success rates in older patients undergoing a SPARC sling as compared with a younger cohort of patients. Parity, hysterectomy and previous pelvic organ prolapse/anti-incontinence surgery may also play a role in the difference in outcomes.

Original languageEnglish (US)
Pages (from-to)708-712
Number of pages5
JournalBJU International
Volume108
Issue number5
DOIs
StatePublished - Sep 2011

Keywords

  • geriatrics
  • incontinence
  • sling

ASJC Scopus subject areas

  • Urology

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