Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence

ObjectivesTo determine significant preoperative risk factors for failure of transobturator tapes.MethodsSecondary analysis of data from the E-TOT (Evaluation of Transobturator Tapes) study. Patient-reported outcomes (n = 310) and objective outcomes (n = 297) were analyzed using univariate and multivariate analyses.ResultsOn univariate analysis, body mass index (BMI) ≥  35, maximum urethral closure pressure (MUCP) ≤ 30 cm H2O, preoperative mixed incontinence on urodynamics, history of at least one previous incontinence procedure, and preoperative symptoms of urgency, nocturia, or urgency incontinence were associated with failure. On multivariate regression, BMI ≥ 35 (OR 6.37; 95% CI, 1.73–23.44; P = 0.005), nocturia (OR 2.18; 95% CI, 1.04–4.58; P = 0.039), urgency incontinence (OR 3.35; 95% CI, 1.07–10.51; P = 0.039), and previous incontinence surgery (OR 2.33; 95%CI, 1.1–5.48; P = 0.048) were independently associated with patient-reported failure. MUCP ≤ 30 cm H2O (OR 7.06; 95% CI, 2.85–17.48; P < 0.001) and previous incontinence procedure (OR 6.22; 95%CI, 2.34–16.52; P < 0.001) were independently associated with objective failure.ConclusionHistory of previous incontinence surgery was the only independent risk factor for failure of transobturator tapes based on both the patient-reported and objective outcome.