# Anxiety Symptoms Before and After Single-Incision Mini-Sling Surgery in Women With Stress Urinary Incontinence: A Prospective Study

## TL;DR

This study found that surgery for stress urinary incontinence in women significantly reduced anxiety symptoms within three months.

## Contribution

The study is the first to prospectively evaluate the impact of single-incision mini-sling surgery on anxiety symptoms in women with stress urinary incontinence.

## Key findings

- 93% of participants achieved continence after surgery.
- Mean total STAI anxiety scores decreased significantly postoperatively.
- Women with moderate SUI were more likely to reach normal anxiety levels than those with severe SUI.

## Abstract

Objective

To evaluate the impact of single-incision mini-sling (SIMS) surgery on anxiety symptoms in women with moderate to severe stress urinary incontinence (SUI), using the State-Trait Anxiety Inventory (STAI).

Methodology

A prospective cohort study was conducted in a tertiary urogynecology center (December 2022-January 2023). Forty-three women with SUI or mixed urinary incontinence (MUI; co-occurrence of stress and urgency symptoms) undergoing SIMS were assessed preoperatively and at three months postoperatively using STAI, International Consultation on Incontinence Questionnaire (ICIQ), Female Lower Urinary Tract Symptoms (FLUTS), and Patient Global Impression of Improvement (PGI-I)/Patient Global Impression of Severity (PGI-S). Women with prior incontinence surgery or pelvic organ prolapse were excluded; current psychotropic medication use with anxiolytic/antidepressant effects (e.g., Selective Serotonin Reuptake Inhibitors (SSRIs), benzodiazepines, Serotonin-Norepinephrine Reuptake Inhibitors/Tricyclic Antidepressants (SNRIs/TCAs), buspirone, atypical antipsychotics, mood stabilizers) was also excluded. STAI-State and STAI-Trait were primary outcomes; total STAI was secondary.

Results

Postoperatively, 40 (93%) participants achieved continence (negative cough stress test). Mean total STAI decreased from 50.6 ± 8.3 to 45.8 ± 7.3 (P < 0.001). A greater proportion of women with moderate SUI achieved normal STAI (<41) versus severe SUI (P = 0.011). Anxiety reduction did not differ between SUI and MUI, although MUI reported slightly lower satisfaction.

Conclusions

SIMS was associated with high continence rates and significant reductions in anxiety at three months. The findings highlight the psychological burden of incontinence and support integrating mental health assessments into urogynecologic care. Specifically, we recommend preoperative STAI screening to flag high trait anxiety, offering perioperative counseling/referral when indicated, and routine tracking of STAI/ICIQ as patient-reported outcome measures.