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BioMed Research International
Volume 2018, Article ID 6934747, 8 pages
Research Article

Predictors for De Novo Overactive Bladder after Readjustable Mid-Urethral Sling Procedure in Women with Stress Urinary Incontinence due to Intrinsic Sphincter Deficiency

1Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
2Department of Urology, CHA Seoul Station Fertility Center, CHA University, Seoul, Republic of Korea

Correspondence should be addressed to Seung Ryeol Lee;

Received 7 November 2018; Accepted 18 November 2018; Published 26 November 2018

Guest Editor: Damir Franic

Copyright © 2018 Joo Hyun No et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. This study identified noninvasive factors that predict overactive bladder (OAB) after readjustable mid-urethral sling surgery (Remeex system) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Materials and Methods. We retrospectively reviewed the medical records of 130 women with SUI due to ISD [Valsalva leak-point pressure (VLPP) <60 cm H2O] who underwent the Remeex procedure between February 2011 and March 2017. Patients were classified according to OAB symptoms before and 6 months after the Remeex procedure: Group 1, without preoperative and postoperative OAB (n=46); Group 2, without preoperative OAB and with postoperative OAB (de novo OAB, n=15); Group 3, with preoperative OAB and without postoperative OAB (n=25); Group 4, with preoperative and postoperative OAB (n=44). Noninvasive clinical and urodynamic factors were evaluated as predictors of de novo OAB. Results. The four groups significantly differed with respect to age (p=0.036), peak urinary flow rate (PUFR) one month after surgery (post-PUFR, p=0.001), and postvoid residual (PVR) one month after surgery (post-PVR, p=0.005). No significant differences were detected for body mass index, diabetes, multiparity, menopause, previous hysterectomy, previous incontinence surgery, previous pelvic organ prolapse surgery, pyuria, preoperative PUFR, preoperative PVR, maximal cystometric capacity, VLPP, maximum urethral closure pressure, detrusor pressure at PUFR, and detrusor overactivity (p>0.05). Post-PUFR decreased significantly compared with preoperative PUFR in Groups 1, 2, and 4 (p=0.002, p=0.001, and p=0.001, respectively). Pairwise comparisons of post-PUFR and post-PVR revealed statistically significant differences between Group 2 and other groups (p<0.0125). Multivariate logistic regression analyses showed that post-PUFR was the only significant predictor of de novo OAB (odds ratio = 0.823, 95% confidence interval 0.727-0.931, p=0.002). Conclusions. Reduced PUFR after the Remeex procedure is a promising predictor of risk for de novo OAB. This metric is noninvasive and easy to measure.