Diabetes mellitus and body weight as risk factors for de-novo urgency after trans-obturator mid-urethral sling.

BACKGROUND

Mid-urethral slings (MUS) are the first-line surgical treatment for stress urinary incontinence (SUI). Despite their efficacy, de-novo urgency (dUU) remains a common and distressing postoperative complication. This study aimed to assess the incidence of dUU following trans-obturator MUS using the Monarc® system, and to identify risk factors associated with its development.

METHODS

This retrospective study included women who underwent Monarc® MUS between 2009 and 2017 at a tertiary medical center. Patients with less than 12 months of follow-up or pre-existing urinary urgency were excluded. Data on demographics, medical history, and concomitant procedures were extracted. The primary outcome was dUU, defined as a newly reported compelling urge to void at 12 months postoperatively. Univariate logistic regression was used to identify associated risk factors.

RESULTS

Of 305 women, 63 met inclusion criteria. At 12 months, dUU occurred in 31.7 % of patients. Preoperative diabetes mellitus (30 % vs. 2.3 %, p = 0.003) and higher BMI (median 28.7 vs. 26.0 kg/m2, p = 0.002) were significantly associated with dUU. Age, parity, and concomitant pelvic floor surgeries were not significantly associated. The subjective cure rate for SUI was 93.7 %.

CONCLUSIONS

The incidence of dUU after trans-obturator MUS was higher than previously reported. Diabetes mellitus and elevated BMI emerged as significant risk factors. These findings support the inclusion of metabolic status in preoperative counselling and highlight the potential value of weight and glycemic management in improving postoperative outcomes for women undergoing SUI surgery.