Incontinence Outcomes in Women Undergoing Primary and Repeat Midurethral Sling Procedures

Abstract

Objective-To assess stress urinary incontinence (SUI) and other lower urinary tract symptom outcomes in women undergoing a repeat midurethral sling compared to those undergoing primary midurethral sling.Material and Methods-Cure was defined as responses of "not at all" or "somewhat" to both questions of the SUI subscale of the Urogenital Distress Inventory-6 (UDI-6); symptom impact was assessed using the Incontinence Impact Questionnaire-7. Multivariable models were created controlling for baseline Medical Epidemiologic and Social Aspects of Aging questionnaire urge score and UDI-6 stress subscale score.Results-1316 subjects had charts available for review. 135/1316 (10.2%) had undergone prior midurethral sling. 799/1329 (60%) questionnaires were returned, with 92 having undergone prior midurethral sling. Median follow-up time was 36.4 months with a range of 11.4 to 71.5 months. Cure rates were 71% (95% CI 67.7%, 74.3%), in the primary midurethral sling group and 54% (95% CI 43.8%, 64.2%) in the repeat MUS group (p<0.001). Repeat midurethral sling women had significantly greater improvement on symptom specific QOL compared to primary midurethral sling women (−28.87 ± 37.6 versus −18.42 ± 32.73, p=0.01). Multivariable analyses revealed that women in the repeat midurethral sling group had increased risk of SUI failure (OR 1.7, 95% CI: 1.1, 2.8).Conclusion-Women undergoing repeat midurethral sling had almost 2 times the odds of stress incontinence treatment failure, but greater improvement in symptom impact on QOL to women undergoing a primary midurethral sling. This information can help counsel patients regarding their expectations of repeat midurethral sling surgery for recurrent SUI.

Surgical outcome of a repeat midurethral sling procedure after failure of a first procedure

“…In the present study, the repeat MUS procedure was successful in 37 of 53 patients (69.8 %) with recurrent or persistent SUI with a mean follow-up of 54.6 months. Although it is difficult to compare the findings of studies because differences in the definitions of success or cure, our results are similar to those reported previously [9,[13][14][15][16]. The success rate in this study was higher than those of other minimally invasive treatments for persistent or recurrent SUI.…”

“…Lee et al reported that a repeat MUS procedure had a cure rate of 75.9 % in 29 patients with failure of the initial procedure after a mean follow-up of 18.1 months [13]. Stav et al [14] and Parden et al [16] also found overall subjective cure rates following repeat MUS procedures of 62 % and 54 % with mean follow-up periods of 50 and 38 months, respectively. Another retrospective study in 80 patients showed subjective and objective cure rates following MUS procedures of 61.0 % and 63.5 %, respectively, with a mean follow-up of 44.8 months [15].…”

“…Although Stav et al [14] and Parden et al [16] found that the subjective cure rates of a repeat MUS procedure (62 % and 54 %, respectively; p<0.001) were significantly lower than those of the primary procedure (86 % and 71 %, respectively; p<0.001), in the present study the difference in the success rates between the repeat and the primary procedures was not statistically significant (69.8 % and 76.5 %, respectively; p= 0.369). This might be related to the differences in the procedures used to choose the repeat MUS procedure.…”

“…Furthermore, there was a significantly higher amelioration of QOL assessed by using the I-QOL questionnaire after surgery in the repeat MUS procedure group than in the primary MUS procedure group (Table 2). This might have been associated with worse baseline symptom scores and the relatively short follow-up duration in those undergoing the repeat procedure (Table 1), or heightened patient appreciation of any symptom improvement after a repeat procedure [16].…”

“…Treatment options for managing a failed MUS qq include transurethral injection of a bulking agent, retropubic suspension, a pubovaginal sling procedure, and a repeat MUS procedure [11,12]. Of these, a repeat MUS procedure is considered a good option with favorable results [13][14][15][16]. However, few studies have attempted to assess the efficacy of repeat MUS procedures for the treatment of persistent or recurrent SUI with a short-term follow-up.…”