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BACKGROUND: Intrinsic sphinteric deficiency (ISD) is a challenging clinical condition to treat. Our objective was to study a cohort of women with a presenting diagnosis of MUI undergoing distal urethral polypropylene sling (DUPS). We questioned whether the urodynamic presence of ISD impacted surgical outcomes.
METHODS: An IRB approved retrospective review of a cohort of 275 women undergoing DUPS for urinary incontinence between October 2008 and January 2011. Self-reported validated questionnaire (UDI-6) and urodynamic (UDS) data was analyzed. Women were identified and evaluated with UDS for complaints of MUI assessed during the initial history and physical examination. We categorized intrinsic sphincteric deficiency (ISD +) as abdominal leak point pressure (either cough/valsalva) less than 60cm/h2O. Continuous data were analyzed using student's t-test and categorical data via the Pearson Chi Square test.
RESULTS: MUI diagnosis was present in 183/275 patients (66%) and data at one year follow up from DUPS was available for 157 patients (85%). Mean age was 59 years (23-87). ). A total of 51 patients had UDS evidence of intrinsic sphincter deficiency (ISD+) and 106 did not (ISD-). Table 1 shows UDS and UDI-6 characteristics of ISD+ and ISD- patient groups. Although there was no difference among UDI-6 total scores, these improved significantly when compared to preoperative values. SUI symptoms were satisfactory (UDI-6 #3) in 88% (93/106) in the ISD- and 90% (46/51) in ISD+. Patients with ISD have a smaller mean cystometric capacity (MCC) (p=0.026). Patients with ISD also have lower detrusor leak point pressure (DLPP) (p<0.05).
CONCLUSIONS: UDI-6 total scores improve significantly in both patient groups postoperatively at one year. Patients with MUI and ISD appear to have lower MCC and higher DLPP on UDS. Urodynamic presence of ISD appears not to impact surgical outcomes of patients with MUI undergoing DUPS.

Table 1. Urodynamic parameters and UDI-6 total score

	First sens. (ml)	Strong sens. (ml)	MCC (ml)	DO+ N (%)	DLPP mean (cmH20)	ALPP mean (cmH20)	Preop UDI-6	Postop UDI-6
ISD-	48	251	420	18 (17%)	25	111	52	13
ISD+	67	245	390	17 (33%)	24	29	55	10
p value	0.224	0.833	0.026	0.021	0.879	<0.001	0.42	0.44