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International Urogynecology Journal

, Volume 23, Issue 9, pp 1279–1284 | Cite as

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

  • Ji-Yeon Han
  • Kyung Hyun Moon
  • Chang Myeon Park
  • Myung-Soo Choo
Original Article

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.

Keywords

Midurethral sling Reoperation Urinary incontinence, stress 

Notes

Conflicts of interest

None.

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Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Ji-Yeon Han
    • 1
  • Kyung Hyun Moon
    • 3
  • Chang Myeon Park
    • 4
  • Myung-Soo Choo
    • 2
  1. 1.Department of Urology, Pusan National University Yangsan HospitalPusan National University School of MedicineYangsanKorea
  2. 2.Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSongpa-guKorea
  3. 3.Department of UrologyUlsan University Hospital, University of Ulsan College of MedicineUlsanKorea
  4. 4.Department of Urology, Gangneung Asan HospitalUniversity of Ulsan College of MedicineGangneungKorea

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