Monday, November 8, 2010

Do slings work in women over 80 years of age with urinary incontinence?

Does age matter when it comes to treating women with slings for urinary incontinence? Will the sling work the same way, are there added complications for older women? What are the risk factors that lead to sling failure?

These are just some of questions recently addressed by some researchers from Australia when they went back to look at 1,225 patients of theirs that had undergone midurethral sling surgery over the course of approximately 8 years. Various types of slings such as TVT, SPARC, Monarc and TVT-O were used. Of the group, 96 women were 80 years and older with an average age of 85, while their younger cohort’s average age was 58 years. Interestingly, the older women averaged more childbirth, used more pads per day to catch urine leakage, and were also found to have worse urinary incontinence when tested pre-operatively.

For the entire group of women, the overall success rate was 85%, with the elderly women averaging 81% cure and the younger group average 85%, which were statistically equivalent. Importantly, the elderly group was more likely to fail their first attempt to void after surgery vs. the younger group, 37% vs. 9%, but the elderly women were ultimately as successful in finally voiding when compared to the younger women.

What were some risk factors for possible sling failure, whether young or old?

BMI >25

Mixed urinary incontinence (both Stress Incontinence and Urge Incontinence)

Previous anti-incontinence surgery

Diabetes

Severe sphincter dysfunction

Vaginal prolapse surgery done at the same time

The rate of complications overall were similar between the two groups, although hospitalization was longer in the elderly group as one may expect, if other medical issues are present. The rate of developing new urinary urgency was also similar.

Elderly patients may be more complex and may have other medical conditions, or have more severe urinary incontinence, however despite this, they appear to tolerate sling surgery well, which is minimally invasive and can benefit from it, if appropriate and desired.

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