Brennand, ErinMetcalfe, AmyHughes, Taylor Ann Marie2024-06-242024-06-242024-06-21Hughes, T. A. M. (2024). 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 (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.https://hdl.handle.net/1880/119015https://doi.org/10.11575/PRISM/46611Background: 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.enUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.epidemiologywomen's healthsurgeryEpidemiologymaster thesis