Browsing by Author "Hughes, Taylor Ann Marie"

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    Overactive Bladder 5 years After the Mid-Urethral Sling Tensioning (MUST) Trial: Prospective Cohort Study Following a Multi-centre Randomized Controlled Trial in Alberta, Canada
    (2024-06-21) Hughes, Taylor Ann Marie; Brennand, Erin; Metcalfe, Amy; Fidler-Benaoudia, Miranda; Fiest, Kirsten
    Background: Mid-urethral slings (MUS) are the preferred surgical treatment for female stress urinary incontinence. However, a small subset of MUS patients experiences overactive bladder (OAB) requiring further treatment. The Mid-Urethral Sling Tensioning (MUST) Trial was a randomized controlled trial that compared MUS outcomes for intraoperative tensioning techniques: the Babcock clamp and Mayo Scissor. The trial provides an opportunity to gauge OAB after MUS through follow-up of a randomized controlled trial using patient reported outcomes and administrative health data. Objective: To assess the burden of overactive bladder (OAB) 5 years after MUS insertion using medication, surgical intervention and patient-reported OAB outcomes, and to compare OAB outcomes by MUS tensioning technique. Methods: MUST trial participants provided 5-year post-MUS data via patient-reported questionnaires linked to administrative health data. OAB burden was assessed by analyzing changes in pre- and 5-year post-op scores on validated OAB questionnaires, post-op OAB medication use and incidence of bladder onabotulinumtoxinA procedures. Results: Of the 318 MUST trial participants, 260 completed questionnaire data at 5 years; among them, 225 (86.9%) reported baseline OAB symptoms and 211 (81.5%) post-MUS. 127 (48.9%) experienced clinically significant worsening in at least one OAB symptom: 19.0% in daily urination, 22.5% in urgency, 18.1% in urine leakage, 23.9% in nightly urination; conversely, 38.7%, 40.3%, 47.6%, and 23.9% showed a significant improvement in these respective domains. Of total participants, 21.4% used OAB medication with a median start at 151 days post-op for a median duration of 319 days. Seven underwent an onabotulinumtoxinA procedure. In comparison of groups, the Babcock clamp tensioning technique provided less frequent nightly urination (19.5% versus 28.0%) and less leakage (11.3% versus 24.9%) than the Mayo Scissor. Conclusions: After MUS, 72.3% of patients experienced improvement of at least 1 OAB symptom, 79.2% were stable, and 48.9% reported worsening. 20% of patients trialed OAB medications, but by study end 75% had discontinued. This information advises surgeons and their patients of realistic expectations for OAB outcomes after MUS. Surgeons can freely choose tensioning techniques, expecting no significant difference in OAB outcomes.