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Management of recurrent stress urinary incontinence after failed midurethral sling: tape tightening or repeat sling?

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Abstract

Introduction and hypothesis

This study was performed to compare surgical outcomes of repeat midurethral sling (MUS) with those of tape shortening in patients who underwent failed initial MUS.

Methods

We assessed 66 patients who underwent failed initial MUS and a second surgical procedure because of recurrent or persistent stress urinary incontinence (SUI), including 36 who underwent repeat MUS and 30 who underwent tape shortening. All patients were followed up for at least 12 months after second surgery. Efficacy was measured by cure rates on the Sandvik questionnaire. Safety was evaluated by assessing maximal urine flow rate, postvoid residual urine volume, and procedure-related complications.

Results

The cure rate was significantly higher in patients who underwent repeat MUS (72.2 % vs. 46.7 %, p = 0.034). Among patients with a Valsalva leak point pressure (VLPP) of <60 cmH2O or SUI severity of at least moderate, the cure rate was significantly higher in those who underwent repeat MUS than in those who underwent tape shortening (76.5 % vs. 40.0 % and 79.2 % vs. 43.8 %, respectively). Univariate analysis of preoperative factors demonstrated that there were no risk factors associated with the cure rates in either group. One patient who underwent repeat MUS required tape cutting, and one who underwent tape shortening experienced mesh erosion. A limitation of this study is that it was not a randomized, controlled study.

Conclusions

Repeat MUS has a higher cure rate than does tape shortening in surgical treatment of patient with persistent or recurrent SUI, especially those with low VLPP or high SUI grade.

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Author information

Authors and Affiliations

  1. Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Gyeongnam, Korea

    Ji-Yeon Han

  2. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, 138-736, Seoul, Korea

    Myung-Soo Choo

  3. Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

    Kyung Hyun Moon

  4. Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

    Chang Myeon Park

Authors
  1. Ji-Yeon Han
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  2. Kyung Hyun Moon
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  3. Chang Myeon Park
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  4. Myung-Soo Choo
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Corresponding author

Correspondence to Myung-Soo Choo.

Appendix: Sandvik questionnaire

Appendix: Sandvik questionnaire

  1. 1.

    How often do you experience urine leakage?

    1. (1)

      Less than once a month

    2. (2)

      One or several times a month

    3. (3)

      One or several times a week

    4. (4)

      Every day and/or night

  2. 2.

    How much urine do you lose each time?

    1. (1)

      Drops or little

    2. (2)

      More

The severity index is created by multiplying the results of questions 1 and 2:

  • 1-2 = slight

  • 3-4 = moderate

  • 6-8 = severe

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Han, JY., Moon, K.H., Park, C.M. et al. Management of recurrent stress urinary incontinence after failed midurethral sling: tape tightening or repeat sling?. Int Urogynecol J 23, 1279–1284 (2012). https://doi.org/10.1007/s00192-012-1737-8

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  • DOI: https://doi.org/10.1007/s00192-012-1737-8

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