Overactive Bladder 5 Years After the Mid-Urethral Sling Tensioning (MUST) Trial
Bibliographic record
Abstract
IMPORTANCE: The midurethral sling (MUS) procedure is the gold standard surgical treatment for stress urinary incontinence; however, it can significantly affect symptoms of overactive bladder (OAB). OBJECTIVES: This study aimed to evaluate the burden of OAB 5 years after MUS insertion by analyzing medication prescriptions, surgical intervention and patient-reported data, with comparisons by sling tensioning technique. STUDY DESIGN: This prospective cohort study followed participants of the Mid-Urethral Sling Tensioning trial for 5 years post-MUS surgery. Participants completed validated OAB questionnaires before and 5 years post-MUS surgery. Linked administrative health data measured postoperative OAB medication use, and incidence of bladder onabotulinumtoxinA (Botox) procedures. RESULTS: Of the 318 participants, 260 had complete questionnaire data; among them, 225 (86.9%) had baseline OAB symptoms and at 5 years post-MUS surgery, 211 (81.5%) had symptoms. Approximately 1 in 5 reported clinically significant worsening in OAB symptoms; 19.0% in daily urination, 22.5% in urgency, and 18.1% in urine leakage. Conversely, 38.7%, 40.3%, and 47.6% showed significant improvement in these respective symptoms. In the 5 years after MUS surgery, 21.4% trialed OAB medication with 5.3% persisting at study end, and 2.2% (n=7) underwent a Botox procedure. The Babcock clamp tensioning technique provided less OAB burden compared with Mayo Scissor; however, the study was underpowered to detect statistical significance. CONCLUSIONS: After MUS surgery, twice the proportion of patients experienced improved OAB symptoms than the proportion reporting worsening. Trials of OAB medications after MUS surgery were common, but most patients discontinued use long term. This study advises surgeons and patients of realistic OAB expectations after MUS surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".