Morbidity of incontinence surgery in women over 70 years old: a retrospective cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 112; no. 6; pp. 786 - 790
• Main Authors: Pugsley, Harriet, Barbrook, Christopher, Mayne, Christopher J., Tincello, Douglas G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK and Malden, USA Blackwell Science Ltd 01.06.2005; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Female; Gynecology; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Middle Aged; Morbidity; Nephrology. Urinary tract diseases; Older people; Polyglactin 910 - therapeutic use; Postoperative Complications - etiology; Retrospective Studies; Surgery; Suture Techniques; Treatment Outcome; Urinary incontinence; Urinary Incontinence, Stress - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Uterine Prolapse - surgery; Vagina - surgery; Women; Human; Urinary system disease; Gynecology; Urinary tract disease; Obstetrics; Morbidity; Retrospective; Urinary incontinence; Voiding dysfunction; Treatment; Surgery; Cohort study; Adult; Female; Bladder disease
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2004.00522.x

Objective  To compare the success rate and complications after colposuspension and tension‐free vaginal tape (TVT) insertion in women aged 70 years or more compared with younger women. Design  A retrospective study of patients having surgery between November 2000 and October 2002. Setting  A tertiary referral, academic urogynaecology unit in a University teaching hospital. Population  Two hundred and twenty‐six women having surgical treatment for urinary incontinence. Methods  Data on cure/improvement and complications were extracted from the notes. Patients were grouped by age at surgery and the odds ratios (OR) and 95% confidence intervals (CI) for each outcome were calculated. Main outcome measures  Subjective cure rate and the incidence of complications by age group. Results  One hundred and three patients had colposuspension, 11 (10.7%) aged 70 or more. One hundred and twenty‐three patients had TVT insertions, 23 (18.7%) aged 70 or more. The cure rate for each procedure was similar between age groups. After colposuspension, urinary tract infection (UTI; OR 11.33; 95% CI 2.61, 49.28) and long term self‐catheterisation (percentage of difference 9.1; 95% CI 3.0, 15.2) were more common in women over 70. After TVT, repeat urodynamics (OR 3.91; 95% CI 1.11, 13.76), recurrent UTI (OR 4.22; 95% CI 1.03, 17.26) and tape division (OR 29.12; 95% CI 3.20, 264.86) were more common in older women. Conclusions  Incontinence surgery carries a higher risk of complications in the elderly including UTI and voiding dysfunction. Extended antibiotic prophylaxis and intermittent self‐catheterisation training should be offered to elderly women before surgery.