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NEUROLOGY & FEMALE UROLOGY
doi: 10.1590/S1677-553820100001000031
Repeat
synthetic mid urethral sling procedure for women with recurrent stress
urinary incontinence
Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Chao F, De Souza
A, Thomas E, Murray C, Conway C, Lee J
Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria,
Australia
J Urol. 2010; 183: 241-6
- Purpose:
We reported and compared the outcomes of repeat mid urethral sling with
primary mid urethral sling in women with stress urinary incontinence.
Materials and Methods: A total of 1,225 consecutive women with urodynamic
stress incontinence underwent a synthetic mid urethral sling procedure
(955 retropubic, 270 transobturator) at our institution between 1999
and 2007. Of the patients 91% (1,112) were interviewed via telephone
call with a structured questionnaire and were included in the analysis.
Mean +/- SD followup was 50 +/- 24 months (range 12 to 114). A comparison
between repeat (77, mean age 62 +/- 12 years) and primary (1,035, mean
age 60 +/- 13 years) mid urethral sling groups was performed. Repeat
sling was placed without removal of the previous sling.
Results: The preoperative incidence of intrinsic sphincter deficiency
was higher in patients who had a repeat mid urethral sling (31% vs 13%,
p <0.001). The subjective stress incontinence cure rate was 86% and
62% in the primary and repeat group, respectively (p <0.001). The
repeat retropubic approach was significantly more successful than the
repeat transobturator approach (71% vs 48%, p = 0.04). The rates of
sling related and general postoperative complications were similar between
the primary and the repeat groups. However, de novo urgency (30% vs
14%, p <0.001) and de novo urge urinary incontinence (22% vs 5%,
p <0.001) were more frequent in the repeat group compared with the
primary group.
Conclusions: A repeat synthetic mid urethral sling procedure has a significantly
lower cure rate than a primary mid urethral sling procedure. The repeat
retropubic approach has a higher success rate than the repeat transobturator
approach. The incidence of de novo urgency and urge incontinence are
significantly higher in repeat procedures.
- Editorial
Comment
This is a report on the efficacy of the repeat mid- urethral sling after
a failed mid urethral sling. The authors examined an impressive pool
of patients numbering well over a thousand of which 77 patients had
a repeat mid-urethral sling. The authors noted a significantly lower
rate of success (62%) as well as a fairly high rate of failure of the
repeat transobturator sling of salvaging continence (53% or less). The
authors were able to collate the results of their surgeries through
the use of clinical interaction as well as telephone communication.
To assess the results, a questionnaire made of select questions from
previous validated questionnaires was utilized. The patient population
was fairly young being between 60 and 62 years of age. It was noted
that the repeat surgery group suffered from a higher rate of de novo
urgency as well as urinary urge incontinence.
This study is very important in view of its’ large numbers and
examining the efficacy of mid-urethral sling. Take home messages include
the confirmation of the difficulty in salvaging previously failed mid-urethral
sling procedures as well as the fairly important singular finding of
the limited efficacy of a transobturator sling to salvage either a failed
retropubic or a previous transobturator sling. The difficulty in salvaging
a gold standard operation has been noted in the past with regard to
pubovaginal slings with autologous fascia (1). For further reading on
management of failed suburethral slings, I direct the reader to an excellent
reference summary article authored by Scarpero and Dmochowski (2).
References
- Petrou
SP, Frank I: Complications and initial continence rates after a repeat
pubovaginal sling procedure for recurrent stress urinary incontinence.
J Urol. 2001; 2001. 165(6 Pt 1): p. 1979-81.
- Scarpero
HM, Dmochowski RR: Sling failures: what’s next? Curr Urol Rep.
2004 Oct;5(5):389-96.
Dr.
Steven P. Petrou
Professor of Urology, Associate Dean
Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu
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