Midurethral sling procedures for stress urinary incontinence in women over 80 years

Aims: To compare the safety and efficacy of midurethral sling surgery for management of urinary stress incontinence in women over 80 years versus younger women. Methods: 1225 consecutive women with urodynamic stress incontinence had a synthetic midurethral sling (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Ninety one percent (n = 1112) of the patients were interviewed via phone call with a structured questionnaire and were included in the analysis. The mean follow-up was 50 ± 24 months (range 12- 114). Comparison between elderly (≥80 years, n = 96) and younger patients (<80 years, n = 1016) was performed. Results: The overall subjective cure rate was 85% (elderly 81%, younger 85%, P = 0.32). There was no significant difference in cure rate between retropubic and transobturator sling in the elderly group (82% vs. 79.3%, P = 0.75). The bladder perforation rate was similar between the two groups (3%). The hospitalization time was significantly longer in the elderly (1.6 ± 1.7 days vs. 0.7 ± 1.1 days, P<0.001). However, major perioperative complications were uncommon (1%). Of the patients who had an isolated sling procedure, 37% of the elderly and 9% of the young patients failed their 1st trial of void (P < 0.001). However, the long-term rate of voiding difficulty was similar between the two groups (elderly 8% vs. young 6%, P = 0.21). The rate of de novo urge incontinence was similar between the two groups (7%). Conclusion: Retropubic and transobturator slings in women older than 80 years are effective and safe but are associated with an increased risk of transient postoperative voiding difficulty.