Background: Although pubovaginal slings (PVS) are commonly used to treat mixed urinary incontinence (MUI), some patients continue to experience urinary symptoms after the surgery. Our goal was to determine if MUI patients with preoperative urodynamic detrusor instability reported more bothersome urinary symptoms after PVS compared to those without urodynamic instability.
Methods: Women with MUI treated with cadaveric fascia or polypropylene pubovaginal slings were identified from three surgeons’ surgical case logs between June 1998 and April 2005. To be classified as MUI, patients needed to experience concomitant symptoms of stress incontinence and urgency/urge incontinence more than once a week. Before surgery, all patients completed a 24 hour voiding diary, physical exam, and standardized fluoroscopic multichannel urodynamic testing. Group A included patients with involuntary 5 cm H20 detrusor pressure rises during urodynamics that were associated with urgency. Group B patients had no involuntary detrusor pressure rises with urgency. All patients completed the Urogenital Distress Inventory (UDI) questionnaire, a validated urinary specific quality of life instrument, before surgery and at each post operative visit. The change in total UDI score after PVS was calculated for each subject and compared between groups.
Results: A total of 73 patients had been treated with PVS for mixed urinary incontinence, 31 in Group A and 42 in Group B. Median follow up for the study population was 8.1 months. Preoperative total UDI scores were 11.8 and 12.7 (p = 0.30) for Group A and B, respectively. Mean changes in total UDI after PVS were - 8.0 and - 10.2 (p = 0.030) for Group A and B, respectively. Both groups had 3 patients that required additional treatments for stress incontinence after PVS. There were no statistical differences between the groups when comparing demographics characteristics, operative data, preoperative maximum flow rate, preoperative Valsalva leak point pressures, or post void residuals.
Conclusions: Patients with MUI and preoperative urodynamic detrusor instability reported significantly more bothersome urinary symptoms after PVS compared to similar patients without urodynamic instability. Preoperative urodynamic testing is an important screening tool for this patient population before PVS.

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