Midurethral sling for treatment of occult stress urinary incontinence at the time of colpocleisis: A decision analysis

Objective: The objective of this study was to estimate optimal timing for treatment of occult stress urinary incontinence in women undergoing colpocleisis using decision analysis methodology. Methods: A decision tree was constructed comparing concomitant versus staged midurethral slings (MUSs). Simple roll-back methodology was used to determine average 1-year utilities of the compared approaches. Results: One-year overall utility favored the staged approach to treating occult incontinence (0.945 vs 0.908) at time of colpocleisis. However, this difference was less than the accepted minimally important difference for utilities. Multiple 1-way sensitivity analyses of all utilities and probabilities identified few thresholds, confirming model robustness. In our model, only 22.5% of women in the staged group ultimately underwent MUS. Conclusions: Staged and concomitant MUSs have similar overall utilities. Both strategies are clinically reasonable, and surgical decision making should be tailored to individual patient needs and preferences. In our model, a staged approach greatly reduces the number of MUS performed.