To identify preoperative prognostic factors associated with persistent urinary incontinence (UI) following mid-urethral sling (MUS) surgery in women with sonographically confirmed urethral funneling.
Retrospective cohort study.
Tertiary referral center with a specialized urogynecology unit.
Forty-seven women diagnosed with stress UI or stress-predominant mixed UI and urethral funneling on preoperative pelvic floor ultrasound (PFUS), undergoing MUS surgery.
MUS surgery performed retropubic (TVT) or transobturator (TOT) approach.
Preoperative evaluation included clinical assessment, voiding diary, validated symptom questionnaires (ICIQ-UI-SF), and PFUS. Surgical success was defined as complete resolution of incontinence 24 months postoperatively. Persistent UI was observed in 27.7% of patients. On univariate analysis, higher ICIQ-UI-SF scores (p = 0.0023), longer urethral length (p = 0.011), and TOT use (p = 0.0065) were significantly associated with persistent UI. ROC curves identified ICIQ-UI-SF ≥ 18 (AUC = 0.731) and urethral length ≥ 35 mm (AUC = 0.654) as optimal cutoffs. In multivariate analysis, both ICIQ-UI-SF ≥ 18 (OR = 6.2, 95% CI: 1.2-31, p = 0.028) and TOT (OR = 6.8, 95% CI: 1.6-28.5, p = 0.009) remained independent predictors. The model showed good discrimination (AUC = 0.84).
Among women with urethral funneling, greater symptom severity and the use of TOT are independently associated with persistent UI after MUS. The retropubic approach (TVT) may yield better outcomes in this high-risk population. Incorporating these predictors into preoperative decision-making may enhance surgical planning and patient counseling.
European journal of obstetrics, gynecology, and reproductive biology. 2026 Feb 08 [Epub ahead of print]
Enrique González-Díaz, Leticia Padilla Mozo, Ester Fraile López, Camino Fernández Fernández
Pelvic Floor Unit, Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), León, Spain. Electronic address: ., Pelvic Floor Unit, Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), León, Spain.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41671641