Synthetic mid-urethral slings in female spina bifida patients with stress urinary incontinence: Is it worth it?

Abstract

Introduction: The aim of this study was to report the outcomes of synthetic mid-urethral slings (MUS) in female patients with spina bifida and stress urinary incontinence (SUI).

Methods: All female patients with spina bifida who were seen at a national referral center between 2007 and 2021 and who had a history of MUS for SUI were included in a retrospective study. The primary outcome of interest was the continence status at 1year as per patients' subjective perception categorized as complete continence, improved continence, unchanged or worsened SUI.

Results: Out of 339 female spina bifida patients; 11 patients had undergone a MUS insertion and were included for analysis (3.2%). The median age was 30years (range: 19-52years). There were four postoperative complications (36.4%). The three patients fully continent at three months were still fully continent at one year (27.3%) while three had improved continence (27.3%) and five had unchanged continence (45.5%). After a median follow-up of 102months, only one patient was still fully continent (9.1%) and three patients had still improved continence (27.3%). Five patients (45.5%) underwent a subsequent anti-incontinence procedure. The only adverse predictor of improved/complete continence at 1year was a sacral neurological level (OR=0.05; p=0.03).

Conclusion: MUS in women with spina bifida and SUI appears to be safe but less effective than in the non-neurogenic population which may be explained by different underlying pathophysiological mechanisms. These findings question the relevance of this treatment option in these complex population, especially in the current mesh controversy era.

Keywords: Bandelette sous-urétrale; Incontinence urinaire; Mid-urethral sling; Neurogenic; Neurogène; Spina bifida; Urinary bladder; Urinary incontinence; Vessie.