OC18.01: Are stress and urgency urinary incontinence associated with levator ani muscle avulsions, muscle contraction or TVT‐location after surgery?

Our aim was to study any associations between stress- and urgency incontinence, levator ani muscle avulsions, muscle contraction or TVT-location 10-20 years after surgery. Cross-sectional study in 2022 of 263 women operated with TVT in 2001-2012. We used transperineal ultrasound to diagnose levator avulsions. Then the TVT-distance from bladder neck at rest and symphysis pubis during Valsalva was measured. A validated questionnaire grading stress (0-12) and urgency (0-8) incontinence symptoms was used. Contraction was assessed by palpation, using the Modified Oxford Scale (MOS). A cough-jump pad-weighing-test with minimum 200ml bladder volume was also performed. Independent samples t-test and Spearmans rank correlation was used for analyses. Mean (SD) age was 62.1 (11.9) years, BMI 26.5 (4.6) kg/m2 and time since surgery 16.4 (4.5) years. 35.8% (91/254) had levator avulsions. Mean MOS was 3.2 (SD 1.2). No difference between women with or without levator avulsions regarding stress index 2.5 (SD 3.2) vs 2.3 (SD 2.8), urgency index 2.6 (SD 2.2) vs 2.6 (SD 2.0) or gram leakage on cough-jump-test 1.1 (SD 4.6) vs 2.4 (SD 15.7) was found, p > 0.05. Objective leakage and symptoms (stress incontinence index) were not correlated with contraction (MOS) or TVT-location (all rs range 0.01 to 0.15, p > 0.05). There was a weak correlation between urgency incontinence index with contraction and TVT location (rs 0.17-0.22, p < 0.05). We found no association between levator avulsions or muscle contraction with objective leakage, stress or urgency urinary incontinence symptoms 10-20 years after surgery. This indicates that the TVT compensates for a weak pelvic floor in women many years after surgery. TVT is a standardised procedure and it seems that minor differences in tightness of the TVT or location along the urethra are of less importance for symptoms, Still, we found a weak correlation between urgency incontinence index with contraction and TVT location.