The Outcome of Repeated Mid Urethral Sling in SUI Treatment after Vaginal Excisions of Primary Failed Sling: Preliminary Study

Abstract

Mid urethral sling is the standard in SUI treatment. Nevertheless, the risk of reoperation reaches 9%. There is no consensus as to the best treatment option for complications. A question is raised: what is the optimal way to achieve the best result in patients after primary failure? The aim of the study was to evaluate the outcomes of repeat MUS surgery in patients after excision of the sling with recurrent SUI. We compared its effectiveness with uncomplicated cases treated with TVT. 27 patients who underwent the repeated MUS and 50 consecutive patients after primary TVT were enrolled in the study. After 6 months, we have found that 24 (88.46%) patients from repeat sling group and 48 (96%) patients after primary sling were dry (1-hour pad test, 2 g or less). The difference between groups was not significant. We showed statistically significant improvement of quality of life in both groups. In conclusion, we showed that repeated sling after MUS excision is almost as effective as primary MUS. We postulate that sling excision and repeated MUS may be the best option for persistent SUI and/or complications after MUS procedures. Further multicenter observations are ongoing as to provide results on bigger group of cases.

Does the suburethral sling change its location?

“…Treatment of persistent SUI is the subject of many clinical trials. There are different approaches to solve the problem, including second sling implantation, sling incision or sling excision with postponed second sling implantation …”

“…The repeated sling implantation might also cause complications influencing patients’ quality of life, such as overactive bladder de novo, urinary retention, pelvic plain syndrome and others. In contrast, there is some evidence that repeated sling after a failed sling excision might have similar effectiveness as the primary procedure . Still, such protocol requires two or more further surgeries, which is hardly acceptable for patients.…”

“…There are different approaches to solve the problem, including second sling implantation, sling incision or sling excision with postponed second sling implantation. 19,20 It should be stressed that repeat suburethral sling implantation without excision of the failed one is usually not as effective as the primary procedure. It was shown that women undergoing repeat sling procedures have a nearly twofold increase in the odds of treatment failure than those undergoing a primary surgery.…”

“…In contrast, there is some evidence that repeated sling after a failed sling excision might have similar effectiveness as the primary procedure. 20,22 Still, such protocol requires two or more further surgeries, which is hardly acceptable for patients.…”

The effectiveness of a pre-pubic four-arm NAZCA-TC mesh in treating cystocele and stress urinary incontinence simultaneously — results controlled with a pelvic floor ultrasound. A preliminary study

“…That is why the literature suggests that the tape located near the middle part of the urethra be first excised and a new tape be implanted a few weeks later [17][18][19]. Because NAZCA-TC is implanted near the urethra, it would be valuable to check its location along the urethra and to evaluate its influence on the urethral mobility.…”