Management of recurrent stress urinary incontinence after failed midurethral sling: tape tightening or repeat sling?
- 492 Downloads
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.
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.
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.
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.
KeywordsMidurethral sling Reoperation Urinary incontinence, stress
Conflicts of interest
- 3.Ulmsten U, Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7:81–5; discussion 5–6Google Scholar
- 6.Angioli R, Plotti F, Muzii L, Montera R, Panici PB, Zullo MA (2010) Tension-Free Vaginal Tape Versus Transobturator Suburethral Tape: Five-Year Follow-up Results of a Prospective, Randomised Trial. Eur UrolGoogle Scholar
- 7.Groutz A, Rosen G, Gold R, Lessing JB, Gordon D (2011) Long-Term Outcome Results of the Inside-Out Transobturator Tension-Free Vaginal Tape: Efficacy and Risk Factors for Surgical Failure. J Womens Health (Larchmt)Google Scholar
- 10.Lee KS, Doo CK, Han DH, Jung BJ, Han JY, Choo MS (2007) Outcomes following repeat mid urethral synthetic sling after failure of the initial sling procedure: rediscovery of the tension-free vaginal tape procedure. J Urol 178:1370–4; discussion 4Google Scholar
- 11.Lo TS, Wang AC, Liang CC, Long CY, Lee SJ (2006) Treatment for unsuccessful tension-free vaginal tape operation by shortening pre-implanted tape. J Urol 175:2196–9; discussion 9–200Google Scholar
- 19.Villet R, Ercoli A, Atallah D, Hoffmann P, Salet-Lizee D (2002) Second tension-free vaginal tape procedure and mesh retensioning: two possibilities of treatment of recurrent-persistent genuine stress urinary incontinence after a primary tension-free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct 13:377–9PubMedCrossRefGoogle Scholar
- 25.Bai SW, Jung YH, Jeon MJ, Jung da J, Kim SK, Kim JW (2007) Treatment outcome of tension-free vaginal tape in stress urinary incontinence: comparison of intrinsic sphincter deficiency and nonintrinsic sphincter deficiency patients. Int Urogynecol J Pelvic Floor Dysfunct 18:1431–4PubMedCrossRefGoogle Scholar
- 27.Abdel-Fattah M, Ramsay I, Pringle S, Hardwick C, Ali H, Young D, et al. (2011) Evaluation of Transobturator Tension-free Vaginal Tapes in Management of Women With Recurrent Stress Urinary Incontinence. UrologyGoogle Scholar