Predictive Factors for Poor Outcome after Laparoscopic and Open Colposuspension: A Comparative Analysis Using the BSUG Database

Introduction: Colposuspension has been a well-accepted surgical treatment for stress urinary incontinence (SUI) since 1961. However, there is limited research on predictors of poor outcomes in both laparoscopic colposuspension (LC) and open colposuspension (OC) procedures. This study aimed to identify predictors linked to patient-reported failure after colposuspension.

Methodology: This was a retrospective cohort study of women who underwent their first colposuspension surgery. The data were collected prospectively on the British Society of Urogynaecology database. The primary outcome measure was the Patient Global Impression of Improvement (PGII) for incontinence; PGII score 3-7 was defined as failure.

Results: A total of 3104 women (1181 in LC and 1923 in OC) were analysed. On multivariate analyses, having a cystocele stage ≥ 2 was significantly predictive of failure (OR 2.573, 95% CI 1.086-6.098; p = 0.032) in LC. In OC, previous midurethral sling (MUS) procedure (OR 1.807, 95% CI 1.169-2.795; p = 0.008) and previous prolapse surgery (OR 1.954, 95% CI 1.235-3.093; p = 0.004) independently, were significant predictors of failure. OC had higher success (better PGII) than LC (p < 0.001), whilst adverse events such as blood loss, rates of urinary retention and duration of admission (p < 0.001) were lower in LC.

Conclusion: Variables found to be independently significant for failed colposuspension were different in the two approaches. Previous pelvic organ prolapse surgery and/or midurethral sling appeared to be the most significant predictors for failed OC, whilst in the LC group, having a stage ≥ 2 cystocele was predictive of failure.