Resolution of urge symptoms following sling cystourethropexy

Purpose: Persistence of urinary urge symptoms in women after pubovaginal sl ing cystourethropexy is a distressing problem. We assess the ability of pre operative video urodynamics to identify patients in whom urinary urge sympt oms failed to resolve postoperatively. Materials and Methods: The records of 84 consecutive women who had undergon e pubovaginal sling cystourethropexy were reviewed. Preoperative video urod ynamics revealed stress urinary incontinence in all cases and concomitant d etrusor instability in some. Cases of motor urge, defined as urge symptoms plus detrusor instability, were divided into low and high pressure categori es. Patients with urge symptoms but no demonstrable detrusor instability on video urodynamics were diagnosed with sensory urge. Postoperatively comple te urge resolution was defined as total absence of symptoms without pharmac ological therapy. Mean followup was 26.7 months (range 2 to 62). Results: Of the 84 patients 41 with motor urge and 28 with sensory urge had preoperative urge symptoms. Complete resolution or improvement in urge sym ptoms occurred in 24 (58.5%) and 7 (17.1%) of the motor urge, and 11 (39.3% ) and 9 (32.1%) of sensory urge cases, respectively. Of the 41 patients wit h motor urge 23 had low pressure instability, which completely resolved in 21 (91.3%) and improved in 2 (8.7%). Of the 18 remaining patients with high pressure motor urge only 5 (27.8%) had complete resolution of urge and 5 ( 27.8%) had improvement. Conclusions: Our results suggest that patients with low pressure motor urge are significantly more likely to experience resolution of urinary urge sym ptoms after pubovaginal sling cystourethropexy than those with high pressur e motor urge or sensory urge.