This study aimed to predict who will undergo midurethral sling surgery (surgery) following initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. Data from 198/230 women who were randomized to physiotherapy was available for analysis, of whom 97/198 (49 %) crossed over to surgery. Prognostic factors for undergoing surgery after physiotherapy were age <55 years at baseline (OR 2.87; 95 % CI 1.30-6.32), higher educational level (OR 3.28; 95 % CI 0.80-13.47), severe incontinence at baseline according to the Sandvik index (OR 1.77; 95 % CI 0.95-3.29) and Urogenital Distress Inventory; incontinence domain score (OR 1.03; per point; 95 % CI 1.01-1.65). Additionally, there was interaction between age <55 years and higher educational level (OR 0.09; 95 % CI 0.02-0.46). Using these variables, a prediction rule was constructed to estimate the risk of surgery after initial physiotherapy.
The study found that in women with moderate to severe stress incontinence, individual prediction for surgery after initial physiotherapy is possible, thereby enabling shared decision making for the choice between initial conservative or invasive management of stress urinary incontinence.