Repeat Synthetic Mid Urethral Sling Procedure for Women With Recurrent Stress Urinary Incontinence

Purpose

We reported and compared the outcomes of repeat mid urethral sling with primary mid urethral sling in women with stress urinary incontinence.

Materials and Methods

A total of 1,225 consecutive women with urodynamic stress incontinence underwent a synthetic mid urethral sling procedure (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Of the patients 91% (1,112) were interviewed via telephone call with a structured questionnaire and were included in the analysis. Mean ± SD followup was 50 ± 24 months (range 12 to 114). A comparison between repeat (77, mean age 62 ± 12 years) and primary (1,035, mean age 60 ± 13 years) mid urethral sling groups was performed. Repeat sling was placed without removal of the previous sling.

Results

The preoperative incidence of intrinsic sphincter deficiency was higher in patients who had a repeat mid urethral sling (31% vs 13%, p <0.001). The subjective stress incontinence cure rate was 86% and 62% in the primary and repeat group, respectively (p <0.001). The repeat retropubic approach was significantly more successful than the repeat transobturator approach (71% vs 48%, p = 0.04). The rates of sling related and general postoperative complications were similar between the primary and the repeat groups. However, de novo urgency (30% vs 14%, p <0.001) and de novo urge urinary incontinence (22% vs 5%, p <0.001) were more frequent in the repeat group compared with the primary group.

Conclusions

A repeat synthetic mid urethral sling procedure has a significantly lower cure rate than a primary mid urethral sling procedure. The repeat retropubic approach has a higher success rate than the repeat transobturator approach. The incidence of de novo urgency and urge incontinence are significantly higher in repeat procedures.

Key Words: recurrence, urinary incontinence, stress, suburethral slings, reoperation

Abbreviations and Acronyms: BMI, body mass index, ISD, intrinsic sphincter deficiency, MUCP, maximal urethral closure pressure, MUS, mid urethral sling, SUI, stress urinary incontinence, TOV, trial of void, TVT, tension-free vaginal tape, UDI, Urogenital Distress Inventory, UUI, urge urinary incontinence, VLPP, Valsalva leak point pressure