Quality of life following transobturator sling surgery for female stress urinary incontinence

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Methods: This was aretrospective cohort study based on data from 51 women consecutivelyundergoing this procedure at our hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery Factors associated with treatment failure were determined through binary logistic regression. Results: Five years after surgery, quality of life scores were good. The rate of treatment failure was 12%. Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome. Conclusion: Sling treatment for incontinence was successful in most participants and remained effective 5 years after surgery in terms of quality of life. transobturator sling TOT TVT-O Sandvick ICIQ-IU-SF stress urinary incontinence Figures Figure 1 Figure 2 Introduction Urinary incontinence (UI) is a common problem thought to affect millions of people that is grossly underreported due to a common belief that it is a natural condition associated with ageing. According to the latest data, UI affects as many as 17–60% of women, making it one of the most common chronic diseases [ 1 ]. Urinary incontinence is defined as the involuntary passing of urine through the urethra. The most common type of UI is stress urinary incontinence (SUI), which accounts for as many as 50% of all incontinence cases among women, and is typically induced by a sudden increase in intra-abdominal pressure, such as when sneezing or laughing [ 1 ]. The aetiology of this form of incontinence in women has been attributed to factors such as age, menopause or obesity [ 2 ], although other possible causes are neurological diseases, metabolic diseases, diuretics, pelvic surgery, and situations of a chronic increase in intraabdominal pressure such as in obesity [ 3 ]. Among the techniques most widely used to treat SUI is the placement of a retropubic tension-free vaginal tape (TVT) or transobturator tape (TOT or TVT-O) midurethral sling. While reported outcomes of both approaches have been similar, transobturator slings have been associated with fewer complications, and shorter surgical time and hospital stay [ 4 ]. The effects of predisposing factors for SUI on the success of sling treatment, however, have been little explored [ 3 ]. Urine leakage significantly reduces quality of life affecting both physical and mental well-being. The impact of incontinence on quality of life largely depends on the severity of symptoms [ 1 ]. The aim of our study was to assess quality of life presurgery, postsurgery and at 5 years in women undergoing transobturator sling placement for the treatment of stress urinary incontinence. Material and methods A retrospective cohort study was designed to include all women who consecutively underwent transobturator sling surgery for the treatment of STU at our centre (Hospital Universitario Lucus Augusti, Lugo, Spain) in the years 2014 and 2015. The main outcome variable was quality of life determined presurgery and in two follow-up visits: the first visit was scheduled for approximately 6 months after surgery and the second assessment was performed at least 5 years later in 2020. This outcome variable was assessed using questionnaires commonly used in clinical practice to identify the type of UI a person has and its impact on quality of life: Sandvick severity test and International Consultation on Incontinence short form quality of life questionnaire (ICIQ-IU-SF). The Sandvick severity test assesses urine leakage frequency and quantity, and its result is a score obtained by multiplying the results of both questions. In this instrument, quality of life impairment was defined as mild (1–2 points), moderate (3–6 points), severe (8–9 points), or very severe (12) [ 5 ]. The ICIQ-UI-SF questionnaire consists of 3 items (frequency, quantity and impact) and 8 more questions related to symptoms guiding a diagnosis of UI type. Replies to these last questions are not considered in the final score, rather they provide information about the circumstances that may cause UI. Accordingly, for each patient, the final score from 0 to 21 was calculated as the sum of the scores obtained for the first 3 items [ 6 ]. Other outcome variables considered here were intraoperative complications (bleeding and/or bladder, urethra or nerve injury), postoperative complications (infection, urine retention, and others), and treatment failure (persistence of SUI). The independent variables compiled were age, weight, height, body mass index (BMI), smoking, occupation (work and/or exercise load), comorbidities (diabetes mellitus and neurological disease), history of previous gynaecological surgery, obstetric formula, menopause, location and degree of pelvic organ prolapse, results of stress test (coughing) and urodynamics study (UDS), and early complications (mesh extrusion, de novo urgency, pelvic pain, dyspareunia, urinary tract infection, and others). To identify overweight and obesity, we used the BMI [ 7 ]. To examine the impact of BMI on treatment outcome, the cohort was divided into the groups: normal weight 18.5–24.9 kg/m 2 , overweight 25-29.9 kg/m 2 , and obese ≥ 30 kg/m 2 . All data were obtained through the electronic medical records of patients with their prior informed consent. Qualitative variables are provided as frequency distributions and quantitative variables as the mean and standard deviation (SD), or median and interquartile range (IQR) when not showing a normal distribution. Qualitative variables were compared using the chi-square test and quantitative variables using the Student's t-test for independent samples or the Mann-Whitney U test for non-normally distributed data. Primary outcome variables were analyzed using the Student's t test for paired data and absolute mean effects are presented together with their 95% confidence intervals (95%CI). A binary logistic regression model was constructed to identify factors associated with treatment failure, including clinically relevant variables. All statistical tests were performed using the software package STATA ver. 15.0. Significance was set at p < 0.05. Table 1.- Qualitative variables recorded in the study participants undergoing surgical sling treatment for stress urinary incontinence N % Year 2014 38 74.5 2015 13 25.5 Smoking No 38 80.9 Smoker 5 10.6 Former smoker 4 8.5 Work/loading exercise No 26 61.9 Yes 16 38.1 Diabetes mellitus No 44 86.3 Yes 7 13.7 Neurological disease No 50 98.0 Yes 1 2.0 Previous surgeries No 38 74.5 Abdominal HT 4 7.8 Vaginal HT 5 9.8 POP treatment 2 3.9 SUI treatment 2 3.9 Second previous surgery No 12 85.7 POP treatment 2 14.3 Menopause No 6 11.8 Yes 45 88.2 Cystocoele grade 0 25 49.0 1 8 15.7 2 7 13.7 3 11 21.6 Rectocoele grade 0 34 66.7 1 5 9.8 2 10 19.6 3 2 3.9 Hysterocoele grade 0 28 65.1 1 3 7.0 2 8 18.6 3 3 7.0 4 1 2.3 Dome prolapse grade 0 7 87.5 2 1 12.5 Urethra prolapse grade 0 50 98.0 1 1 2.0 Abbreviations. - HT: Hysterectomy; POP: Pelvic organ prolapse; SUI: stress urinary incontinence. Results The study population consisted of 51 women diagnosed with SUI who underwent transobturator tape surgery (TOT/TVT-O) in the years 2014 and 2015 at our centre. The demographic and clinical characteristics of the subjects enrolled are provided in Tables 1 and 2 . Participants were of a mean age of 62 years (SD 10, IQR 54–70), 38 of whom underwent surgery in 2014 (74.5%, 38/51) and 13 in 2015 (25.5%, 13/51). In the whole cohort, 39 women (78%, 39/50) had had ≥ 2 pregnancies, and at least 1 vaginal delivery was recorded in 46 women (92%, 46/50). 88.2% (45/51) of the women were in menopause at the time of surgical treatment. The mean BMI was 28.96 kg/m 2 (SD 4.84; IQR 25.64–31.53). Table 2 Quantitative variables recorded in the study participants undergoing surgical sling treatment for stress urinary incontinence Abbreviations. – SD: standard deviation; BMI: body mass index. Mean (SD) Median P25 P75 Minimum Maximum Age (years) 62 (10) 62 54 70 43 83 Weight (kg) 71 (13) 71 61 77 52 120 Height (cm) 157 (5) 157 153 160 142 166 BMI (kg/m 2 ) 28.961 (4.84) 29.17 25.64 31.53 19.81 47.4 Pregnancies 3 (2) 2 2 3 0 7 Vaginal delivery 2 (1) 2 1 3 0 6 Caesarean section 0 (0) 0 0 0 0 2 Abortion 0 (1) 0 0 0 0 3 The presurgery examination results, SUI diagnosis, type of intervention and intra/postoperative complications are shown in Table 3 . At baseline (presurgery), 91.3% (42/46) of the participants returned a positive stress test. The urodynamics study revealed isolated stress urinary incontinence in 97.8% (45/46) of the patients. Table 3 Presurgical study results and diagnosis, type of intervention and intra/postoperative complications recorded in the study participants undergoing surgical sling treatment for stress urinary incontinence N % Stress test Negative 4 8.7 Positive 42 91.3 Urodynamics study SUI 45 97.8 UUI 1 2.2 Presurgical diagnosis SUI 24 47.1 MUI 27 52.9 Surgery TOT 28 54.9 TOT + POP 22 43.1 TOT + abdominal surgery 1 2 Treatment approach TOT (out-in) 37 72.5 TVT-O (in-out) 14 27.5 Intraoperative complications No 47 92.2 Vaginal perforation 4 7.8 Postoperative complications No 50 98 Urinary retention 1 2 Abbreviations. – SUI: stress urinary incontinence; UUI: urge urinary incontinence; MUI: mixed urinary incontinence, TOT: transobturator tape; POP: pelvic organ prolapse; TVT: transvaginal tape. 54.9% (28/51) of our patients underwent transobturator mesh insertion, while the remaining women (45.1%, 23/51) underwent transobturator mesh insertion and another type of intervention such as prolapse surgery at the same time. In 72.5% (37/51) of the women, the transobturator approach was TOT (out-in), while in 27.5% (14/51) it was TVT-O (in-out). The most frequent intraoperative complications recorded were vaginal perforation in 4 women (7.8%, 4/51). The most frequent postoperative complication was urinary retention which was recorded in 1 patient (2%, 1/51). Table 4 includes the qualitative variables that were collected at the first visit after surgery. The mesh extrusion rate was 4% (2/50) and technique failure rate was 12% (6/50). Table 4 Qualitative variables recorded in the first follow-up visit (around 6 months) after surgery N % Incomplete bladder emptying No 44 88 Yes 6 12 Mesh extrusion No 48 96 Yes 2 4 De novo urgency No 48 96 Yes 2 4 Technique failure No 44 88 Yes 6 12 Pelvic pain No 41 82 Yes 9 18 Dyspareunia No 49 98 Yes 1 2 UTI No 44 88 Yes 6 12 Abbreviations. – UTI: urinary tract infection. Complete 5-year follow-up data were available for 35 patients. The impact of treatment on quality of life assessed through the ICIQ-IU-SF questionnaire (Table 5 ), was a mean score reduction of 9.47 (95% CI 6.93–12.02; p < 0.001) in the first follow-up visit, and one of 8.78 (95% CI 6.43–11.14; p < 0.001) 5 years after surgery compared to the baseline score. The effects of sling treatment on the frequency and severity of urine leakage was a reduction of 5.46 (95% CI 4.17–6.74; p < 0.001) and one of 4.54 (95% CI 3.25–5.83; p < 0.001) in the Sandvick severity test score recorded in the first and 5-year follow-up visits, respectively, compared to baseline, respectively. Table 5 Impact of treatment on quality of life (questionnaire scores) over time (baseline, 6 months and 5 years postsurgery) N Mean (SD) baseline Mean (SD) Mean absolute effect CI95% P ICIQ-IU-SF (baseline – 6 months) 35 14.55 (4.46) 5.08 (6.16) 9.47 6.93 12.02 < 0.001 ICIQ-IU-SF (baseline – 5 years) 35 14.22 (4.32) 5.43 (5.89) 8.78 6.43 11.14 < 0.001 Sandvick (baseline – 6 months) 35 7.66 (2.31) 2.2 (2.46) 5.46 4.17 6.74 < 0.001 Sandvick (baseline – 5 years) 35 7.46 (2.16) 2.92 (3.33) 4.54 3.25 5.83 < 0.001 Abbreviations. – SD: standard deviation; CI95%: 95% confidence interval; ICIQ-IU-SF: International Consultation on Incontinence Questionnaire Short-Form. In the logistic regression model built to assess factors associated with treatment failure in the first post-surgery visit (at around 6 months), we included age, BMI, multiparity, and a history of previous gynaecological surgery as possible predisposing factors. The independent factors emerging as related to treatment failure were multiparity (p = 0.005) and previous gynaecological surgery (p = 0.019). When quality of life impacts were compared according to surgical approach (in-out vs. out-in) no significant differences were detected between the two groups. To examine whether obesity could affect the results obtained, quality of life score improvements were compared across BMI groups. This analysis indicated that obese women showed a lower significant decrease in the score over time (p < 0.05) (Figs. 1 and 2 ). Discussion In this cohort of women with SUI undergoing transobturator sling surgery, good results were obtained in terms of quality of life 5 years after treatment. Multiparity and previous pelvic surgery were identified as predisposing factors for treatment failure. Obesity was associated with a poorer quality of life. Our study participants were 51 women of mean age 62 ± 10 years, with a mean BMI of 28.96 ± 4.84 kg/m 2 , and a mean of 2 ± 1 vaginal deliveries each. These characteristics are similar to those described by Kołodynska et al. for their study population [ 8 ]. Multiparity and previous gynaecological surgery were here identified as independent factors for treatment failure, which occurred in 12% of our cohort. These findings are consistent with most reported results such as those of a recent meta-analysis by Falah-Hassani et al. [ 9 ], in which the risk of SUI in general was found to increase with multiparity, obesity and smoking. In the review carried out by Capobianco et al., risk factors identified for the recurrence or persistence of SUI after surgery were age, obesity, comorbidities (e.g., diabetes mellitus), a history of previous SUI, mixed UI and failure of previous incontinence surgery [ 10 ]. In our cohort, obesity emerged as a factor associated with a worse prognosis in terms of quality of life after surgical treatment. These results are similar to those of studies that have followed individuals subjected to this treatment. Thus, Hagan et al. detected a strong link between a higher BMI and the progression of UI severity, regardless of age [ 11 ]. Similar findings were reported by Lamerton et al. [ 7 ], who mentioned that the relationship between obesity and UI was a public health concern as we expect a continuous rise in obesity rates and therefore UI rates. As previously highlighted, UI has psychological impacts and significantly reduces quality of life, so this needs to be considered when trying to assess the effectiveness of treatment [ 8 , 12 ]. The International Continence Society (ICS) recommends the use of quality of life as an outcome variable in clinical trials [ 13 ]. Moreover, according to the United Kingdom's National Institute for Health and Clinical Excellence (NICE), validated questionnaires on quality of life are needed to choose the best treatment in each individual. However, the different questionnaires vary and there is no consensus about which one gives the best results. One of the questionnaires used in our study was the International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF). In a recent systematic review by Wuytack et al., this instrument was found to indicate of successful outcome with a specificity of 85% and a sensitivity of 90% when the score was over 6 [ 13 ]. The Spanish version of ICIQ-UI-SF has proved its reliability, internal consistency and validity to describe the impact of UI on quality of life, and also to diagnose the type of UI in clinical practice [ 14 ]. In the long-term posttreatment (5 years), we here observed a significant mean reduction of 8.78 points in the ICIQ-IU-SF score obtained. This figure is slightly higher than that obtained by Croghan et al., who detected a mean reduction in ICIQ-IU-SF score of 6.32, although for 9.4 years of follow up [ 15 ]. According to the recommendations of the European Society of Urology (EAU), the treatment of UI should start with conservative management [ 8 ]. In the systematic review published by Radzimińska et al., it was concluded that pelvic floor rehabilitation through at least 6 months of physiotherapy was most effective for SUI [ 12 ]. If conservative treatment fails or in cases of severe UI, surgical treatment is indicated [ 8 , 16 ]. The goal of surgical treatment is to restore the anatomy and function of the urinary system. The high rate of complications associated with the retropubic approach (TVT) led to the development of suburethral slings inserted through the obturator foramen, which include the "out-in" (TOT) or "in-out" (TVT-O) procedures. As concluded in the meta-analysis by Huang et al [ 17 ], the transobturator approach shows a similar efficacy and lower rate of complications, and also reduces surgical times and hospital stay. In our study, no differences were found between TOT and TVT-O, as confirmed in the meta-analyses by Oliveira et al. [ 18 ] and Fusco et al. [ 19 ]. The rate of complications recorded in our participants was lower than those reported in similar series. Frohme et al. [ 20 ] obtained an intraoperative complication rate of 23.2% (27/116 women), most of which were minor (de novo urgency, dyspareunia, urinary retention, and vaginal perforation). In a similar cohort as the present in terms of age and BMI, Natale et al. noted a de novo urgency rate of 6.4% in the 5-year follow-up session compared to our rate of 4% [ 21 ]. The mesh extrusion rate in our cohort was 4%, which is similar to reported figures of 4.5% (14/314 women) by Karmakar et al. [ 22 ] and 4.2% (61/1439 women) by Kokanali et al [ 23 ], and highlights a history of previous pelvic surgery as a prognostic factor for mesh extrusion. A lower rate of mesh extrusion was, however, described in a review by Linder et al. (1.5-2% of cases) [ 24 ]. However, these authors detected the appearance of vascular lesions (pelvic hematoma) in up to 2% of patients after transobturator tape insertion compared to our rate of 0% [ 24 ]. Figures reported for failure of surgical UI treatment vary widely. Thus, for simple midurethral sling placement, Henry de Villeneuve et al. [ 25 ] recorded a 14.2% failure rate at 12 months, while Pardo Schanz et al. [ 26 ] obtained a 5% failure rate. Due to the weakening of the pelvic structures, pelvic organ prolapse (POP) and UI are conditions that often coexist. In these patients, anti-incontinence surgery associated with POP repair has been shown to reduce the risk of postoperative SUI [ 11 ]. This was reflected in our participants, whereby 43.2% of women underwent simultaneous surgery for POP correction. Among the limitations of our investigation was that it was a retrospective single-centre study including patients with characteristic epidemiological features. In effect, many of our participants were elderly women from rural areas with high rates of obesity. Urinary incontinence is an underdiagnosed chronic disease that, besides physical impacts, has considerable social and psychological repercussions. As the consequence of this disease is a significantly worsened quality of life, its diagnosis and treatment must be a priority as in response quality of life significantly improves. When considering surgical treatment, several factors such as multiparity, obesity and previous pelvic surgery should be assessed, as these may lead to worse long-term results. Conclusions Our findings indicate an improvement in quality of life in most women with SUI 5 years after surgical treatment. In this cohort, multiparity and previous pelvic surgery emerged as predisposing factors for treatment failure, and obesity was associated with a poorer quality of life. Declarations Funding : no funding was received. Conflict of interests: The authors declare that they have no conflict of interest. Acknowledgments: The authors thank Cristina Fernández Pérez PhMD, from the Preventive Medicine and Public Health Department of the University Hospital of Santiago de Compostela, for designing the statistical approach used. Statements and Declarations Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing interests: The authors have no relevant financial or non-financial interests to disclose. Author Contributions: All authors contributed to the study conception and design. Gómez-Fernández C was responsible of: protocol development, data collection, data analysis and manuscript writing. Otero-Naveiro A was responsible of: protocol development, data collection, data analysis, manuscript writing and manuscript editing. Raña-Mayan A was responsible of protocol development, data collection and manuscript editing. Pérez-López M, Martínez-López P and Paz-Fernández E were responsible of: protocol development, manuscript review, supervision and project administration. All authors read and approved the final manuscript. Ethics approval : The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Santiago-Lugo on June 13 th 2020 (registration code: 2020/146). 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Eur J Obstet Gynecol Reprod Biol 177:146–150. https://doi.org/10.1016/j.ejogrb.2014.03.039 Linder BJ, Elliott DS (2019) Synthetic Midurethral Slings: Roles, Outcomes, and Complications. Urol Clin North Am 46(1):17–30. https://doi.org/10.1016/j.ucl.2018.08.013 Henry de Villeneuve M, Boualaoui I, El Kharroubi A, Droupy S, Wagner L (2020) Évaluation à court terme de la mini-bandelette Altis® dans l’incontinence urinaire d’effort chez la femme [Short-term evaluation of Altis® single-incision sling in women stress urinary incontinence]. Prog Urol 30(6):346–352. https://doi.org/10.1016/j.purol.2020.03.007 . French Pardo Schanz J, Ricci Arriola P, Tacla Fernández X, Betancourt Ortiz E (2007) Cinta trans-obturadora (TOT) en la corrección de la incontinencia de orina de esfuerzo. Experiencia de tres años con 200 pacientes [Trans obturator tape (TOT) for female stress incontinence. Experience with three years follow-up in 200 patients]. Actas Urol Esp 31(10):1141–1147. https://doi.org/10.1016/s0210-4806(07)73777-4 . Spanish Cite Share Download PDF Status: Published Journal Publication published 01 Jun, 2024 Read the published version in Actas Urológicas Españolas (English Edition) → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3299934","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":229299263,"identity":"46346df9-189e-4224-85bd-7fbd0d448277","order_by":0,"name":"Cristina Gómez Fernández","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"Gómez","lastName":"Fernández","suffix":""},{"id":229299264,"identity":"6fde3734-0c2a-49df-9f4f-11fcbee68dcf","order_by":1,"name":"Ana Otero Naveiro","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYDADNgYGxgdAmoePFC3MBiAtbCRZJAHVix/wz25++Lig5rAcn/ThY5Vfc+xk2BiYHz66gUeLxJ1jxsYzjh02ZuNLS7stuy0Z6DA2Y+McfNbcSDCT5mFLS2zj4TG7LbmNGaiFh00anxb5G+nfpHn+pdWDtBRLbqsnrMXgRo6ZNG+bTQIbUAvjx22HCWsxvJFTbMzbZ2PYxsOWLM247TgPGzMBv8jdSN/4mOebhLx8D/PBjz+3VdvzswPDEK/3kQEzD5gkVjkIMP4gRfUoGAWjYBSMGAAAc+87/RjtD9gAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-6574-3719","institution":"Hospital Universitario Lucus Augusti","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Otero","lastName":"Naveiro","suffix":""},{"id":229299265,"identity":"b05ce96f-ae3a-4a33-b50f-7301f5235bdc","order_by":2,"name":"Andrea Raña Mayán","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"Raña","lastName":"Mayán","suffix":""},{"id":229299266,"identity":"600400b2-7dc9-4d10-b82f-f5c3b85a1c34","order_by":3,"name":"Marta Pérez López","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Marta","middleName":"Pérez","lastName":"López","suffix":""},{"id":229299267,"identity":"89001a26-5318-4e5b-ab5b-070bd8fbbaf2","order_by":4,"name":"Pilar Martínez López","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pilar","middleName":"Martínez","lastName":"López","suffix":""},{"id":229299268,"identity":"38320f87-873c-4ffb-a990-c5890530e2b5","order_by":5,"name":"Eugenio Paz Fernández","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eugenio","middleName":"Paz","lastName":"Fernández","suffix":""}],"badges":[],"createdAt":"2023-08-27 08:15:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3299934/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3299934/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1016/j.acuroe.2024.06.001","type":"published","date":"2024-06-01T11:55:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":42454961,"identity":"8a47381c-040d-4d18-99cb-7388c3baa048","added_by":"auto","created_at":"2023-08-31 20:37:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7767,"visible":true,"origin":"","legend":"\u003cp\u003eScores obtained in the ICIQ-IU-SF quality of life questionnaire over time (baseline, 6 months and 5 years postsurgery) according to body mass index\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations. – BMI: body mass index; ICIQ-IU-SF: International Consultation on Incontinence Questionnaire Short-Form.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3299934/v1/657372500249cd8813133729.png"},{"id":42454960,"identity":"30159bf2-a446-4561-8512-023de9f74a78","added_by":"auto","created_at":"2023-08-31 20:37:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":7908,"visible":true,"origin":"","legend":"\u003cp\u003eScores obtained in the Sandvick quality of life questionnaire over time (baseline, 6 months and 5 years post-surgery) according to body mass index\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations. – BMI: body mass index\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3299934/v1/65bb1a9bb2ef3a4ae05a1b27.png"},{"id":58810976,"identity":"b582eb98-a66e-45f0-8fff-160702f85c1a","added_by":"auto","created_at":"2024-06-21 11:55:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":608863,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3299934/v1/d96974df-af0e-4b6d-95a8-73b7e0af4d08.pdf"}],"financialInterests":"","formattedTitle":"Quality of life following transobturator sling surgery for female stress urinary incontinence","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUrinary incontinence (UI) is a common problem thought to affect millions of people that is grossly underreported due to a common belief that it is a natural condition associated with ageing. According to the latest data, UI affects as many as 17\u0026ndash;60% of women, making it one of the most common chronic diseases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrinary incontinence is defined as the involuntary passing of urine through the urethra. The most common type of UI is stress urinary incontinence (SUI), which accounts for as many as 50% of all incontinence cases among women, and is typically induced by a sudden increase in intra-abdominal pressure, such as when sneezing or laughing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The aetiology of this form of incontinence in women has been attributed to factors such as age, menopause or obesity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], although other possible causes are neurological diseases, metabolic diseases, diuretics, pelvic surgery, and situations of a chronic increase in intraabdominal pressure such as in obesity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the techniques most widely used to treat SUI is the placement of a retropubic tension-free vaginal tape (TVT) or transobturator tape (TOT or TVT-O) midurethral sling. While reported outcomes of both approaches have been similar, transobturator slings have been associated with fewer complications, and shorter surgical time and hospital stay [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The effects of predisposing factors for SUI on the success of sling treatment, however, have been little explored [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrine leakage significantly reduces quality of life affecting both physical and mental well-being. The impact of incontinence on quality of life largely depends on the severity of symptoms [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of our study was to assess quality of life presurgery, postsurgery and at 5 years in women undergoing transobturator sling placement for the treatment of stress urinary incontinence.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eA retrospective cohort study was designed to include all women who consecutively underwent transobturator sling surgery for the treatment of STU at our centre (Hospital Universitario Lucus Augusti, Lugo, Spain) in the years 2014 and 2015.\u003c/p\u003e \u003cp\u003eThe main outcome variable was quality of life determined presurgery and in two follow-up visits: the first visit was scheduled for approximately 6 months after surgery and the second assessment was performed at least 5 years later in 2020. This outcome variable was assessed using questionnaires commonly used in clinical practice to identify the type of UI a person has and its impact on quality of life: Sandvick severity test and International Consultation on Incontinence short form quality of life questionnaire (ICIQ-IU-SF). The Sandvick severity test assesses urine leakage frequency and quantity, and its result is a score obtained by multiplying the results of both questions. In this instrument, quality of life impairment was defined as mild (1\u0026ndash;2 points), moderate (3\u0026ndash;6 points), severe (8\u0026ndash;9 points), or very severe (12) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The ICIQ-UI-SF questionnaire consists of 3 items (frequency, quantity and impact) and 8 more questions related to symptoms guiding a diagnosis of UI type. Replies to these last questions are not considered in the final score, rather they provide information about the circumstances that may cause UI. Accordingly, for each patient, the final score from 0 to 21 was calculated as the sum of the scores obtained for the first 3 items [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOther outcome variables considered here were intraoperative complications (bleeding and/or bladder, urethra or nerve injury), postoperative complications (infection, urine retention, and others), and treatment failure (persistence of SUI).\u003c/p\u003e \u003cp\u003eThe independent variables compiled were age, weight, height, body mass index (BMI), smoking, occupation (work and/or exercise load), comorbidities (diabetes mellitus and neurological disease), history of previous gynaecological surgery, obstetric formula, menopause, location and degree of pelvic organ prolapse, results of stress test (coughing) and urodynamics study (UDS), and early complications (mesh extrusion, de novo urgency, pelvic pain, dyspareunia, urinary tract infection, and others).\u003c/p\u003e \u003cp\u003eTo identify overweight and obesity, we used the BMI [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. To examine the impact of BMI on treatment outcome, the cohort was divided into the groups: normal weight 18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e, overweight 25-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e, and obese\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e All data were obtained through the electronic medical records of patients with their prior informed consent.\u003c/p\u003e \u003cp\u003eQualitative variables are provided as frequency distributions and quantitative variables as the mean and standard deviation (SD), or median and interquartile range (IQR) when not showing a normal distribution. Qualitative variables were compared using the chi-square test and quantitative variables using the Student's t-test for independent samples or the Mann-Whitney U test for non-normally distributed data. Primary outcome variables were analyzed using the Student's t test for paired data and absolute mean effects are presented together with their 95% confidence intervals (95%CI). A binary logistic regression model was constructed to identify factors associated with treatment failure, including clinically relevant variables. All statistical tests were performed using the software package STATA ver. 15.0. Significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.-\u003c/strong\u003e Qualitative variables recorded in the study participants undergoing surgical sling treatment for stress urinary incontinence\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e74.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eSmoking\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e80.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eSmoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eFormer smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eWork/loading exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e61.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e86.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eNeurological disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e98.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003ePrevious surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e74.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eAbdominal HT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eVaginal HT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003ePOP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eSUI treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eSecond previous surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003ePOP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eMenopause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e88.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eCystocoele grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e49.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eRectocoele grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eHysterocoele grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eDome prolapse grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003eUrethra prolapse grade\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e98.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.577060931899645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.240143369175627%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.591397849462366%\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations. - HT: Hysterectomy; POP: Pelvic organ prolapse; SUI: stress urinary incontinence.\u003c/em\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study population consisted of 51 women diagnosed with SUI who underwent transobturator tape surgery (TOT/TVT-O) in the years 2014 and 2015 at our centre. The demographic and clinical characteristics of the subjects enrolled are provided in Tables\u0026nbsp;1 and \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Participants were of a mean age of 62 years (SD 10, IQR 54\u0026ndash;70), 38 of whom underwent surgery in 2014 (74.5%, 38/51) and 13 in 2015 (25.5%, 13/51). In the whole cohort, 39 women (78%, 39/50) had had\u0026thinsp;\u0026ge;\u0026thinsp;2 pregnancies, and at least 1 vaginal delivery was recorded in 46 women (92%, 46/50). 88.2% (45/51) of the women were in menopause at the time of surgical treatment. The mean BMI was 28.96 kg/m\u003csup\u003e2\u003c/sup\u003e (SD 4.84; IQR 25.64\u0026ndash;31.53).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuantitative variables recorded in the study participants undergoing surgical sling treatment for stress urinary incontinence \u003cem\u003eAbbreviations. \u0026ndash; SD: standard deviation; BMI: body mass index.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP25\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP75\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.961 (4.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe presurgery examination results, SUI diagnosis, type of intervention and intra/postoperative complications are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. At baseline (presurgery), 91.3% (42/46) of the participants returned a positive stress test. The urodynamics study revealed isolated stress urinary incontinence in 97.8% (45/46) of the patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePresurgical study results and diagnosis, type of intervention and intra/postoperative complications recorded in the study participants undergoing surgical sling treatment for stress urinary incontinence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrodynamics study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSUI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUUI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresurgical diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSUI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMUI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTOT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTOT\u0026thinsp;+\u0026thinsp;POP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTOT\u0026thinsp;+\u0026thinsp;abdominal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTOT (out-in)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTVT-O (in-out)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrinary retention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eAbbreviations. \u0026ndash; SUI: stress urinary incontinence; UUI: urge urinary incontinence; MUI: mixed urinary incontinence, TOT: transobturator tape; POP: pelvic organ prolapse; TVT: transvaginal tape.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e54.9% (28/51) of our patients underwent transobturator mesh insertion, while the remaining women (45.1%, 23/51) underwent transobturator mesh insertion and another type of intervention such as prolapse surgery at the same time. In 72.5% (37/51) of the women, the transobturator approach was TOT (out-in), while in 27.5% (14/51) it was TVT-O (in-out).\u003c/p\u003e \u003cp\u003eThe most frequent intraoperative complications recorded were vaginal perforation in 4 women (7.8%, 4/51). The most frequent postoperative complication was urinary retention which was recorded in 1 patient (2%, 1/51).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e includes the qualitative variables that were collected at the first visit after surgery. The mesh extrusion rate was 4% (2/50) and technique failure rate was 12% (6/50).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQualitative variables recorded in the first follow-up visit (around 6 months) after surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete bladder emptying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMesh extrusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDe novo urgency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnique failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspareunia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eAbbreviations. \u0026ndash; UTI: urinary tract infection.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComplete 5-year follow-up data were available for 35 patients. The impact of treatment on quality of life assessed through the ICIQ-IU-SF questionnaire (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e), was a mean score reduction of 9.47 (95% CI 6.93\u0026ndash;12.02; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the first follow-up visit, and one of 8.78 (95% CI 6.43\u0026ndash;11.14; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) 5 years after surgery compared to the baseline score. The effects of sling treatment on the frequency and severity of urine leakage was a reduction of 5.46 (95% CI 4.17\u0026ndash;6.74; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and one of 4.54 (95% CI 3.25\u0026ndash;5.83; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the Sandvick severity test score recorded in the first and 5-year follow-up visits, respectively, compared to baseline, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact of treatment on quality of life (questionnaire scores) over time (baseline, 6 months and 5 years postsurgery)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD) baseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean absolute effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eCI95%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICIQ-IU-SF (baseline \u0026ndash; 6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.55 (4.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.08 (6.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICIQ-IU-SF (baseline \u0026ndash; 5 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.22 (4.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.43 (5.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSandvick (baseline \u0026ndash; 6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.66 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2 (2.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSandvick (baseline \u0026ndash; 5 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.46 (2.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.92 (3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eAbbreviations. \u0026ndash; SD: standard deviation; CI95%: 95% confidence interval; ICIQ-IU-SF: International Consultation on Incontinence Questionnaire Short-Form.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the logistic regression model built to assess factors associated with treatment failure in the first post-surgery visit (at around 6 months), we included age, BMI, multiparity, and a history of previous gynaecological surgery as possible predisposing factors. The independent factors emerging as related to treatment failure were multiparity (p\u0026thinsp;=\u0026thinsp;0.005) and previous gynaecological surgery (p\u0026thinsp;=\u0026thinsp;0.019). When quality of life impacts were compared according to surgical approach (in-out vs. out-in) no significant differences were detected between the two groups.\u003c/p\u003e \u003cp\u003eTo examine whether obesity could affect the results obtained, quality of life score improvements were compared across BMI groups. This analysis indicated that obese women showed a lower significant decrease in the score over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this cohort of women with SUI undergoing transobturator sling surgery, good results were obtained in terms of quality of life 5 years after treatment. Multiparity and previous pelvic surgery were identified as predisposing factors for treatment failure. Obesity was associated with a poorer quality of life.\u003c/p\u003e \u003cp\u003eOur study participants were 51 women of mean age 62\u0026thinsp;\u0026plusmn;\u0026thinsp;10 years, with a mean BMI of 28.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84 kg/m\u003csup\u003e2\u003c/sup\u003e, and a mean of 2\u0026thinsp;\u0026plusmn;\u0026thinsp;1 vaginal deliveries each. These characteristics are similar to those described by Kołodynska et al. for their study population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMultiparity and previous gynaecological surgery were here identified as independent factors for treatment failure, which occurred in 12% of our cohort. These findings are consistent with most reported results such as those of a recent meta-analysis by Falah-Hassani et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], in which the risk of SUI in general was found to increase with multiparity, obesity and smoking. In the review carried out by Capobianco et al., risk factors identified for the recurrence or persistence of SUI after surgery were age, obesity, comorbidities (e.g., diabetes mellitus), a history of previous SUI, mixed UI and failure of previous incontinence surgery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our cohort, obesity emerged as a factor associated with a worse prognosis in terms of quality of life after surgical treatment. These results are similar to those of studies that have followed individuals subjected to this treatment. Thus, Hagan et al. detected a strong link between a higher BMI and the progression of UI severity, regardless of age [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Similar findings were reported by Lamerton et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], who mentioned that the relationship between obesity and UI was a public health concern as we expect a continuous rise in obesity rates and therefore UI rates.\u003c/p\u003e \u003cp\u003eAs previously highlighted, UI has psychological impacts and significantly reduces quality of life, so this needs to be considered when trying to assess the effectiveness of treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The International Continence Society (ICS) recommends the use of quality of life as an outcome variable in clinical trials [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, according to the United Kingdom's National Institute for Health and Clinical Excellence (NICE), validated questionnaires on quality of life are needed to choose the best treatment in each individual. However, the different questionnaires vary and there is no consensus about which one gives the best results. One of the questionnaires used in our study was the International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF). In a recent systematic review by Wuytack et al., this instrument was found to indicate of successful outcome with a specificity of 85% and a sensitivity of 90% when the score was over 6 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The Spanish version of ICIQ-UI-SF has proved its reliability, internal consistency and validity to describe the impact of UI on quality of life, and also to diagnose the type of UI in clinical practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In the long-term posttreatment (5 years), we here observed a significant mean reduction of 8.78 points in the ICIQ-IU-SF score obtained. This figure is slightly higher than that obtained by Croghan et al., who detected a mean reduction in ICIQ-IU-SF score of 6.32, although for 9.4 years of follow up [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the recommendations of the European Society of Urology (EAU), the treatment of UI should start with conservative management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the systematic review published by Radzimińska et al., it was concluded that pelvic floor rehabilitation through at least 6 months of physiotherapy was most effective for SUI [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIf conservative treatment fails or in cases of severe UI, surgical treatment is indicated [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The goal of surgical treatment is to restore the anatomy and function of the urinary system. The high rate of complications associated with the retropubic approach (TVT) led to the development of suburethral slings inserted through the obturator foramen, which include the \"out-in\" (TOT) or \"in-out\" (TVT-O) procedures. As concluded in the meta-analysis by Huang et al [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the transobturator approach shows a similar efficacy and lower rate of complications, and also reduces surgical times and hospital stay. In our study, no differences were found between TOT and TVT-O, as confirmed in the meta-analyses by Oliveira et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and Fusco et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe rate of complications recorded in our participants was lower than those reported in similar series. Frohme et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] obtained an intraoperative complication rate of 23.2% (27/116 women), most of which were minor (de novo urgency, dyspareunia, urinary retention, and vaginal perforation). In a similar cohort as the present in terms of age and BMI, Natale et al. noted a de novo urgency rate of 6.4% in the 5-year follow-up session compared to our rate of 4% [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mesh extrusion rate in our cohort was 4%, which is similar to reported figures of 4.5% (14/314 women) by Karmakar et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and 4.2% (61/1439 women) by Kokanali et al [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and highlights a history of previous pelvic surgery as a prognostic factor for mesh extrusion. A lower rate of mesh extrusion was, however, described in a review by Linder et al. (1.5-2% of cases) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, these authors detected the appearance of vascular lesions (pelvic hematoma) in up to 2% of patients after transobturator tape insertion compared to our rate of 0% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFigures reported for failure of surgical UI treatment vary widely. Thus, for simple midurethral sling placement, Henry de Villeneuve et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] recorded a 14.2% failure rate at 12 months, while Pardo Schanz et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] obtained a 5% failure rate.\u003c/p\u003e \u003cp\u003eDue to the weakening of the pelvic structures, pelvic organ prolapse (POP) and UI are conditions that often coexist. In these patients, anti-incontinence surgery associated with POP repair has been shown to reduce the risk of postoperative SUI [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This was reflected in our participants, whereby 43.2% of women underwent simultaneous surgery for POP correction.\u003c/p\u003e \u003cp\u003eAmong the limitations of our investigation was that it was a retrospective single-centre study including patients with characteristic epidemiological features. In effect, many of our participants were elderly women from rural areas with high rates of obesity.\u003c/p\u003e \u003cp\u003eUrinary incontinence is an underdiagnosed chronic disease that, besides physical impacts, has considerable social and psychological repercussions. As the consequence of this disease is a significantly worsened quality of life, its diagnosis and treatment must be a priority as in response quality of life significantly improves. When considering surgical treatment, several factors such as multiparity, obesity and previous pelvic surgery should be assessed, as these may lead to worse long-term results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur findings indicate an improvement in quality of life in most women with SUI 5 years after surgical treatment. In this cohort, multiparity and previous pelvic surgery emerged as predisposing factors for treatment failure, and obesity was associated with a poorer quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: no funding was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors thank Cristina Fern\u0026aacute;ndez P\u0026eacute;rez PhMD, from the Preventive Medicine and Public Health Department of the University Hospital of Santiago de Compostela, for designing the statistical approach used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatements and Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e All authors contributed to the study conception and design. G\u0026oacute;mez-Fern\u0026aacute;ndez C was responsible of: protocol development, data collection, data analysis and manuscript writing. Otero-Naveiro A was responsible of: protocol development, data collection, data analysis, manuscript writing and manuscript editing. Ra\u0026ntilde;a-Mayan A was responsible of protocol development, data collection and manuscript editing. P\u0026eacute;rez-L\u0026oacute;pez M, Mart\u0026iacute;nez-L\u0026oacute;pez P and Paz-Fern\u0026aacute;ndez E were responsible of: \u0026nbsp;protocol development, manuscript review, supervision and project administration. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e:\u0026nbsp;The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Santiago-Lugo on June 13\u003csup\u003eth\u003c/sup\u003e 2020 (registration code:\u0026nbsp;2020/146).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e written informed consent was obtained from all individual participants included in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZalewski M, Kołodynska G, Mucha A, Andrzejewski W (2021) A Prospective Study of the Quality of Life of Patients with Stress Incontinence before and after a Transobturator Tape (TOT) Procedure\u0026mdash;Preliminary Report. J Clin Med 10:4571. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jcm10194571\u003c/span\u003e\u003cspan address=\"10.3390/jcm10194571\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurkhard FC, Bosch JLHR, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubar A (2017) European Urology Association (EAU) Guidelines on Urinary Incontinence. EAU, Arnhem, The Netherlands\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeitosa PDS, Cola\u0026ccedil;o NHB, Barros CR, Gollop TR, Marchesini AC (2019) The association between personal history and the outcomes of transobturator sling surgery. Rev Assoc Med Bras 22;65(6):864\u0026ndash;869. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/1806-9282.65.6.864\u003c/span\u003e\u003cspan address=\"10.1590/1806-9282.65.6.864\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang ZM, Xiao H, Ji ZG, Yan WG, Zhang YS (2018) TVT versus TOT in the treatment of female stress urinary incontinence: A systematic review and meta-analysis. Ther Clin Risk Manag 14:2293\u0026ndash;2303. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/TCRM.S169014\u003c/span\u003e\u003cspan address=\"10.2147/TCRM.S169014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandvik H, Seim A, Vanvik A, Hunskaar S (2000) A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. 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Urol Clin North Am 46(1):17\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ucl.2018.08.013\u003c/span\u003e\u003cspan address=\"10.1016/j.ucl.2018.08.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenry de Villeneuve M, Boualaoui I, El Kharroubi A, Droupy S, Wagner L (2020) \u0026Eacute;valuation \u0026agrave; court terme de la mini-bandelette Altis\u0026reg; dans l\u0026rsquo;incontinence urinaire d\u0026rsquo;effort chez la femme [Short-term evaluation of Altis\u0026reg; single-incision sling in women stress urinary incontinence]. Prog Urol 30(6):346\u0026ndash;352. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.purol.2020.03.007\u003c/span\u003e\u003cspan address=\"10.1016/j.purol.2020.03.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. French\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePardo Schanz J, Ricci Arriola P, Tacla Fern\u0026aacute;ndez X, Betancourt Ortiz E (2007) Cinta trans-obturadora (TOT) en la correcci\u0026oacute;n de la incontinencia de orina de esfuerzo. Experiencia de tres a\u0026ntilde;os con 200 pacientes [Trans obturator tape (TOT) for female stress incontinence. Experience with three years follow-up in 200 patients]. Actas Urol Esp 31(10):1141\u0026ndash;1147. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0210-4806(07)73777-4\u003c/span\u003e\u003cspan address=\"10.1016/s0210-4806(07)73777-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Spanish\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"transobturator sling, TOT, TVT-O, Sandvick, ICIQ-IU-SF, stress urinary incontinence","lastPublishedDoi":"10.21203/rs.3.rs-3299934/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3299934/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThis descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis was aretrospective cohort study based on data from 51 women consecutivelyundergoing this procedure at our hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery Factors associated with treatment failure were determined through binary logistic regression.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eFive years after surgery, quality of life scores were good. The rate of treatment failure was 12%. Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eSling treatment for incontinence was successful in most participants and remained effective 5 years after surgery in terms of quality of life.\u003c/p\u003e","manuscriptTitle":"Quality of life following transobturator sling surgery for female stress urinary incontinence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-31 20:37:33","doi":"10.21203/rs.3.rs-3299934/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f575414-8056-425f-b9e8-ff270300ca8d","owner":[],"postedDate":"August 31st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-06-21T11:55:33+00:00","versionOfRecord":{"articleIdentity":"rs-3299934","link":"https://doi.org/10.1016/j.acuroe.2024.06.001","journal":{"identity":"actas-urologicas-espanolas-english-edition","isVorOnly":true,"title":"Actas Urológicas Españolas (English Edition)"},"publishedOn":"2024-06-01 11:55:33","publishedOnDateReadable":"June 1st, 2024"},"versionCreatedAt":"2023-08-31 20:37:33","video":"","vorDoi":"10.1016/j.acuroe.2024.06.001","vorDoiUrl":"https://doi.org/10.1016/j.acuroe.2024.06.001","workflowStages":[]},"version":"v1","identity":"rs-3299934","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3299934","identity":"rs-3299934","version":["v1"]},"buildId":"369fNeqWncA4NS6XSWjrt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}