Management of Recurrent Stress Urinary Incontinence After Failed Mid-Urethral Sling Placement
- 70 Downloads
Purpose of Review
Our objective is to review the current literature on recurrent stress urinary incontinence after mid-urethral sling placement, focusing on evidence-based management considerations for this complex clinical problem.
Conservative, minimally invasive surgical therapies are currently available for management of persistent or recurrent SUI after a previous mid-urethral sling (MUS).
Our review of the literature does not show a clear benefit of one approach over others and emphasizes that the ideal management for these complex patients should be determined using an individualized approach with a detailed discussion of patient symptoms, past surgical history, and goals. For symptomatic patients who are surgical candidates and desire intervention, trans-urethral bulking agents, repeat retropubic (RP) MUS, or salvage autologous pubovaginal (PV) sling appear to be the most well-described management strategies.
KeywordsUrinary incontinence Mid-urethral sling Pubovaginal sling Sling failure
Compliance with Ethical Standards
The research contained in this study did not directly involve human subjects and/or animals and thus no informed consent was necessary.
Conflict of Interest
The authors of this manuscript declare that Dr. Padmanabhan serves as a consultant and speaker for Astellas and consultant for Allergan. Dr. Fontenot has no conflict of interest.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Hunskaar S, Burgio K (2005) Epidemiology of urinary and faecal incontinence and POP. In: Abrams P, Cardozo L (eds) 3rd international consultation on incontinence. [Web page]:255–312.Google Scholar
- 5.Bakali E, Buckley BS, Hilton P, et al. Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women. Cochrane Database Syst Rev. 2013:CD009407. https://doi.org/10.1002/14651858.cd009407.pub2.
- 8.Fialkow M, Symons RG, Flum D. Reoperation for urinary incontinence. Am J Obstet Gynecol. 2008;199(546):e1–8.Google Scholar
- 11.Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V, et al. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2010;58(2):218–38.CrossRefPubMedGoogle Scholar
- 12.Ford AA, Rogerson L, Cody JD, et al. Midurethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2015:CD006375. https://doi.org/10.1002/14651858.cd006375.pub3.
- 13.• Fusco F, Abdel-Fattah M, Chapple CR, Creta M, La Falce S, Waltregny D, et al. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2017; Systematic review discussing SUI management options in 2017. Google Scholar
- 17.Holmgren C, Nilsson S, Lanner L, Hellberg D. Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol. 2005;106:38–43. https://doi.org/10.1097/01.AOG.0000167393.95817.dc.CrossRefPubMedGoogle Scholar
- 18.Domochowski RR, Osborn DJ, Reynolds WS. Slings: autologous, biologic, synthetic and midurethral. Campbell-Walsh Urology. 2016;11:1987–2039.Google Scholar
- 27.Abdel-Fattah M, Ramsay I, Pringle S, et al. Randomized, prospective, single-blinded study comparing ‘inside-out’ vs. ‘outside-in’ transobturator tapes in the management of urodynamic stress incontinence: one-year outcomes from the E-TOT study. BJOG. 2010;117:870–8. https://doi.org/10.1111/j.1471-0528.2010.02544.x.CrossRefPubMedGoogle Scholar
- 28.Maher C, Dwyer P, Carey M, Gilmour D. The Burch colposuspension for recurrent urinary stress incontinence following retropubic continence surgery. Br J Obstet Gynaecol. 1999;106:719–24. https://doi.org/10.1111/j.1471-0528.1999.tb08373.x.CrossRefPubMedGoogle Scholar
- 29.Moore RD, Speights SE, Miklos JR. Laparoscopic Burch colposuspension for recurrent stress urinary incontinence. J Minim Invasive Gynecol. 2001;8(3):389–92.Google Scholar
- 30.• Petrou SP, Davidiuk AJ, Rawal B, et al. Salvage autologous fascial sling after failed synthetic midure-thral sling: greater than three-year outcomes. Int J Urol. 2016;23:178–81. https://doi.org/10.1111/iju.13003. One of a few recent articles looking at salvage sling after MUS. CrossRefPubMedGoogle Scholar
- 33.• Parker WP, Gomelsky A, Padmanabhan P. Autologous fascia pubovaginal slings after prior synthetic anti-incontinence procedures for recurrent incontinence: a multi-institutional prospective comparative analysis to de novo autologous slings assessing objective and subjective cure. Neurourol Urodyn. 2016;35(5):604–8. Recent study looking at PVS use after prior MUS procedure. CrossRefPubMedGoogle Scholar
- 39.• Aberger M, Gomelsky A, Padmanabhan P. Comparison of retropubic synthetic mid-urethral slings to fascia pubovaginal slings following failed sling surgery. Neurourol Urodyn. 2016;35(7):851–4. Recent study comparing MUS to PVS in the setting of prior failed surgery for SUI. CrossRefPubMedGoogle Scholar