Does Pre-Operative Grade of Stress Urinary Incontinence Severity Affect the Post-Operative Outcome? A Systematic Review

Abstract Introduction and Hypothesis It is not known whether assessment of severity of stress urinary incontinence (SUI) is important before any attempt at the correction of it. The aim of this study is to identify the success rates and/or dry rates following interventional treatment in patients with mild, moderate, and severe SUI, and compare the results among the various treatments. Methods This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the Prospective Register of Systematic Reviews System (ID: CRD420251017900), by searching PubMed, Scopus, and Cochrane Library Database from inception to December 2024. The Population, Intervention, Comparison, Outcomes, and Study design criteria were as follows: the ‘Population’ were adult women who underwent an interventional procedure for SUI and had pre- and post-interventional classification of SUI severity. As ‘Intervention’ was considered any type of interventional procedure: colposuspensions, mid-urethral slings (MUS), pubo-vaginal slings, energy-based devices (EBD), and injectables. ‘Comparison’ was considered between either single or comparative interventions according to the pre- and post-operative grade of SUI severity. ‘Outcomes’ were the success rates and/or dry rates according to pre- and post-operative grade of SUI severity. Results From a total of 11,535 studies, 24 (4380 patients) were included for further analysis: in 13 studies ( n = 3599) a graft was used and in 11 studies ( n = 781) other interventions. Successful treatment of mild incontinence was achieved in 84.7% (MUS = 89.6%, EBD = 66.7%, p < 0.001), of moderate incontinence in 88.3% (MUS = 92.0%, EBD = 52.5%, p < 0.001), and of severe/very severe incontinence in 75.7% (MUS = 83.9%, EBD = 44.3%, p < 0.001). Conclusions The success rates of any incontinence procedure depend largely on the pre-operative severity of SUI, and they are significantly lower with increasing severity of the SUI. MUS appear to have improved treatment rates compared with EBD, independently of the severity of SUI.