Repeat mid-urethral sling for the management of recurrent or persistent female stress urinary incontinence
IUGA Academy. Stern J. Jun 30, 2018; 213001
Topic: Stress Incontinence
Jocelyn Stern
Jocelyn Stern

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Repeat mid-urethral sling for the management of recurrent or persistent female stress urinary incontinence

Stern, J1; Alvarez, J2; Andreoli, F1; Urzua, MJ3; Rondini, C2; Monroy, M4; Storme, O5; Giraudo, V6

1: Universidad del Desarrollo and Hospital Padre Hurtado; 2: Hospital Padre Hurtado and Clinica Santa Maria; 3: Hospital Padre Hurtado and Clinica Davila; 4: Hospital Padre Hurtado, Santiago Chile; 5: Hospital Padre Hurtado; 6: Universidad del Desarrollo, Chile

Introduction: The use of mid-urethral slings is a common procedure for treatment of female urinary incontinence with a high success rate. However, in nearly 9% of female patients, stress urinary incontinence may persist o reappear. What procedure to attempt afterwards continuous to be a question.

Objective: The aim of this study is to determine the success rate of a repeat mid-urethral sling and to assess the best approach.

Method: We conducted a retrospective case-control study. The medical records and surgical notes of 36 patients who underwent a repeat mid-urethral sling (MUS) were reviewed from January 2006 to December 2017. The type of MUS used were either transobturator or retropubic, no single incision slings were used. A successful repeat MUS was considered a patient global improvement index of much better or above. Secondary outcome was to evaluate office cystometry variables as a predictor of recurrence.

Results: During the analyzed study period a total of 1407 sling procedure were performed. There were no significant differences in the demographic variables between the repeat sling group and the overall group, as well as no difference between the successful repeat sling and failure group. Of the 36 women who underwent a repeat sling, 23 (63.8%) had a primary transobturator sling (TO) and 13 (36.2%) had a previous retropubic sling. The second procedure or repeat sling was a transobturator tape in 5/36 (13.9%) of patients and 31of the 36 (86.1%) patients had a retropubic sling. Mean time in months between the primary procedure and the repeat sling was significantly higher following a primary retropubic slings (RP), 19 months for TO versus 43 months for RP (p: 0,003). Repeat MUS following a TO procedure had a significantly higher success rate over a previous RP sling (p: 0.022). However, a repeat RP had a similar success rate as repeat TO (p: 0.395). Retropubic sling following a previous RP only had a success rate of 33%. The sequence TO-RP showed a higher patient-satisfaction rate than other combinations. Office cystometry was unable to predict recurrence of stress urinary incontinence.

Conclusion: Repeat mid-urethral slings are a viable option for women with persistent or recurrent stress incontinence who previously underwent a transobturator sling. In these women the retropubic approach is recommended.


Work supported by industry: no.

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