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Incontinence outcomes after “second primary” compared to repeat midurethral sling for recurrent and persistent stress urinary incontinence

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Abstract

Introduction and hypothesis

The current study aims to assess the continence rate of a “second primary” midurethral sling (MUS) in women with recurrent/persistent stress urinary incontinence (SUI) after sling excision compared to a historical cohort who underwent a repeat MUS.

Methods

A retrospective cohort study of women who underwent excision of a primary MUS and placement of a “second primary” MUS from 2009 to 2016 compared to a historical cohort who underwent a repeat MUS from 2006 to 2009. The primary outcome was continence rate, defined as “not at all” or “somewhat” to Urogenital Distress Inventory (UDI-6) SUI subscale questions. Secondary outcomes included assessment of symptom severity (UDI-6), symptom-specific quality of life, Incontinence Impact Questionnaire (IIQ-7), Medical and Epidemiologic Aspects of Aging (MESA), and Patient Global Impression of Improvement (PGI-I).

Results

Survey responses were available for 23/64 (36%) in the “second primary” MUS group versus 88/135 (65%) in the historical cohort. Mean follow-up in months, second primary: 41.8 ± 26.1 versus repeat: 36.2 ± 14.1, p = 0.16 and age (years): 56.4 ± 10.7 versus 59.8 ± 10.8, p = 0.19. Continence rates were 48% in “second primary” versus 56% in the repeat group (p = 0.50). Both groups had significant improvement in questionnaire scores postoperatively with no intergroup differences. Multivariable analysis demonstrated that odds of success did not differ between groups (adjusted odds ratio: 0.73, 95% confidence interval: 0.27–1.99).

Conclusions

In women with recurrent/persistent SUI, repeat and “second primary” MUS procedures demonstrate similar success outcomes and improvement in UI symptom distress and QOL. Continued research is needed for this increasingly important clinical question.

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Acknowledgements

Research reported in this study was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR003096. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Grant support

IM and HER are partially funded by the NIH/NICHD Women’s Reproductive Health Research Career Development Program (5K12HD001258–20).

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA

    Anna K. Melnikoff

  2. Department of Obstetrics & Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Isuzu Meyer & Holly E. Richter

  3. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Kimberly D. Martin

Authors
  1. Anna K. Melnikoff
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  2. Isuzu Meyer
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  3. Kimberly D. Martin
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  4. Holly E. Richter
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Contributions

AK Melnikoff: Data collection, data interpretation, manuscript writing/editing.

KD Martin: Data analysis, manuscript review.

I Meyer: Data analysis and interpretation, manuscript writing/editing.

HE Richter: Project development, data interpretation, manuscript writing/editing.

Corresponding author

Correspondence to Anna K. Melnikoff.

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Disclosures

HE Richter: Research Grants: Renovia, Allergan.

For the remaining authors, none were declared.

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Melnikoff, A.K., Meyer, I., Martin, K.D. et al. Incontinence outcomes after “second primary” compared to repeat midurethral sling for recurrent and persistent stress urinary incontinence. Int Urogynecol J 32, 75–80 (2021). https://doi.org/10.1007/s00192-020-04447-6

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  • DOI: https://doi.org/10.1007/s00192-020-04447-6

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