The study was approved by our hospital’s Clinical Research Ethics Committee under approval number 2024/01/11/011 on 2024-01-24. This retrospective study included 117 patients—selected from a total of 561—who had complete urodynamic data and underwent TOT surgery for SUI at our urology and gynecology clinics between May 2017 and March 2024. Written informed consent was obtained from all participants.
Inclusion criteria were defined as SUI associated with urethral hypermobility, in accordance with the guidelines of the ICS. Exclusion criteria included patients without urodynamic testing, those who had previously undergone pelvic surgery or radiotherapy, individuals with prior incontinence surgery, and patients diagnosed with neurogenic bladder or psychiatric disorders.
Demographic and clinical data, including age, height, weight, body mass index (BMI), number of vaginal and cesarean deliveries, and comorbidities, were recorded. Urodynamic testing was performed using the Locum Plus system (Aymed, Türkiye), following ICS guidelines. Although current guidelines suggest reserving urodynamic evaluation for complex or ambiguous cases, our institution routinely performs preoperative urodynamic testing for all patients undergoing midurethral sling surgery. This policy is based on institutional protocol aimed at improving surgical planning and identifying occult detrusor overactivity or ISD, which could influence postoperative outcomes. As such, all patients in this study underwent urodynamic testing regardless of symptom complexity. VLPP values were stratified into two categories: <90 cm H₂O and >90 cm H₂O. Patients with VLPP <60 cm H₂O who were diagnosed with ISD and treated with periurethral bulking agents were excluded from the study.
All patients underwent a preoperative clinical evaluation, including medical history, physical examination, and urodynamic assessment. The International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) was completed preoperatively and postoperatively. Data on urge incontinence and cystocele were also documented. Frequency, volume, and the impact of urge incontinence on daily life were evaluated separately.
Based on the presence or absence of urge incontinence in the preoperative assessment, 93 patients (79.5%) were classified as having pure stress urinary incontinence, and 24 patients (20.5%) were considered to have mixed urinary incontinence. This classification was used in the comparative analysis of surgical outcomes.
All surgical procedures were performed by the same urologist and gynecologist, each with a minimum of five years of experience in urogynecology. A standardized stress test was conducted for all patients both before and after surgery. A positive postoperative stress test result was considered indicative of treatment failure.
The 90 cm H₂O threshold for VLPP was selected based on previous literature, which suggests that this value more accurately identifies patients at risk of intrinsic sphincter deficiency compared to lower cut-off points.
Statistical Analysis
Statistical analyses were conducted using IBM SPSS Statistics for Windows, version 29.0 (IBM Corp., Armonk, NY, USA). The normality of continuous variables was assessed using the Shapiro–Wilk test. Normally distributed variables were expressed as mean ± standard deviation (SD), while non-normally distributed variables were presented as median and interquartile range (IQR). Categorical variables were summarized as frequencies and percentages.
The Chi-square test was used to assess associations between categorical demographic and clinical variables (e.g., VLPP category, presence of urge incontinence, and postoperative stress test results). The Independent Samples T-test was used to compare continuous variables between two groups (e.g., VLPP <90 cm H₂O vs >90 cm H₂O). The Paired Samples T-test was applied to compare preoperative and postoperative ICIQ-SF scores and their impact on daily life.
To identify independent predictors of surgical success—defined as a negative result on the postoperative stress test—a binary logistic regression analysis was performed. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs).
Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive accuracy of the preoperative “impact on daily life” score for surgical outcomes. The area under the curve (AUC), optimal cut-off value, sensitivity, and specificity were reported.
A p-value of <0.05 was considered statistically significant.
MATERIALS AND METHODS
The study was approved by our hospital’s Clinical Research Ethics Committee under approval number 2024/01/11/011 on 2024-01-24. This retrospective study included 117 patients—selected from a total of 561—who had complete urodynamic data and underwent TOT surgery for SUI at our urology and gynecology clinics between May 2017 and March 2024. Written informed consent was obtained from all participants.
Inclusion criteria were defined as SUI associated with urethral hypermobility, in accordance with the guidelines of the ICS. Exclusion criteria included patients without urodynamic testing, those who had previously undergone pelvic surgery or radiotherapy, individuals with prior incontinence surgery, and patients diagnosed with neurogenic bladder or psychiatric disorders.
Demographic and clinical data, including age, height, weight, body mass index (BMI), number of vaginal and cesarean deliveries, and comorbidities, were recorded. Urodynamic testing was performed using the Locum Plus system (Aymed, Türkiye), following ICS guidelines. Although current guidelines suggest reserving urodynamic evaluation for complex or ambiguous cases, our institution routinely performs preoperative urodynamic testing for all patients undergoing midurethral sling surgery. This policy is based on institutional protocol aimed at improving surgical planning and identifying occult detrusor overactivity or ISD, which could influence postoperative outcomes. As such, all patients in this study underwent urodynamic testing regardless of symptom complexity. VLPP values were stratified into two categories: <90 cm H₂O and >90 cm H₂O. Patients with VLPP <60 cm H₂O who were diagnosed with ISD and treated with periurethral bulking agents were excluded from the study.
All patients underwent a preoperative clinical evaluation, including medical history, physical examination, and urodynamic assessment. The International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) was completed preoperatively and postoperatively. Data on urge incontinence and cystocele were also documented. Frequency, volume, and the impact of urge incontinence on daily life were evaluated separately.
Based on the presence or absence of urge incontinence in the preoperative assessment, 93 patients (79.5%) were classified as having pure stress urinary incontinence, and 24 patients (20.5%) were considered to have mixed urinary incontinence. This classification was used in the comparative analysis of surgical outcomes.
All surgical procedures were performed by the same urologist and gynecologist, each with a minimum of five years of experience in urogynecology. A standardized stress test was conducted for all patients both before and after surgery. A positive postoperative stress test result was considered indicative of treatment failure.
The 90 cm H₂O threshold for VLPP was selected based on previous literature, which suggests that this value more accurately identifies patients at risk of intrinsic sphincter deficiency compared to lower cut-off points.
Statistical Analysis
Statistical analyses were conducted using IBM SPSS Statistics for Windows, version 29.0 (IBM Corp., Armonk, NY, USA). The normality of continuous variables was assessed using the Shapiro–Wilk test. Normally distributed variables were expressed as mean ± standard deviation (SD), while non-normally distributed variables were presented as median and interquartile range (IQR). Categorical variables were summarized as frequencies and percentages.
The Chi-square test was used to assess associations between categorical demographic and clinical variables (e.g., VLPP category, presence of urge incontinence, and postoperative stress test results). The Independent Samples T-test was used to compare continuous variables between two groups (e.g., VLPP <90 cm H₂O vs >90 cm H₂O). The Paired Samples T-test was applied to compare preoperative and postoperative ICIQ-SF scores and their impact on daily life.
To identify independent predictors of surgical success—defined as a negative result on the postoperative stress test—a binary logistic regression analysis was performed. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs).
Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive accuracy of the preoperative “impact on daily life” score for surgical outcomes. The area under the curve (AUC), optimal cut-off value, sensitivity, and specificity were reported.
A p-value of <0.05 was considered statistically significant.