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. 2013 Feb;121(2 Pt 1):273-278.
doi: 10.1097/AOG.0b013e31827c5de7.

Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures

Alison M Parden  1 , Jonathan L Gleason, Victoria Jauk, Rachel Garner, Alicia Ballard, Holly E Richter
Affiliations

Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures

Alison M Parden et al. Obstet Gynecol. 2013 Feb.

Abstract

Objective: To assess stress urinary incontinence (SUI) and other lower urinary tract symptom outcomes in women undergoing repeat midurethral sling procedures compared with those undergoing primary midurethral sling procedures.

Methods: Cure was defined as responses of "not at all" or "somewhat" to both questions of the SUI subscale of the Urogenital Distress Inventory-6; symptom effect was assessed using the Incontinence Impact Questionnaire-7. Multivariable models were created controlling for baseline Medical Epidemiologic and Social Aspects of Aging questionnaire urge score and Urogenital Distress Inventory-6 stress subscale score.

Results: One thousand three hundred sixteen patients had charts available for review: 135 of 1,316 (10.2%) had undergone prior midurethral sling procedures; 799 of 1,316 (61%) questionnaires were returned, with 92 from those having undergone prior midurethral sling procedures. Median follow-up time was 36.4 months with a range of 11.4-71.5 months. Cure rates were 71% (95% confidence interval [CI] 67.7-74.3%) in the primary midurethral sling group and 54% (95% CI 43.8-64.2%) in the repeat midurethral sling group (P<.001). Women undergoing repeat midurethral sling procedures experienced significantly greater improvement in symptom-specific quality of life (QOL) compared with those undergoing primary midurethral sling procedures (-28.87±37.6 compared with -18.42±32.73, P=.01). Multivariable analyses revealed that women in the repeat midurethral sling group had increased risk of SUI failure (odds ratio 1.7, 95% CI 1.1-2.8).

Conclusion: Women undergoing repeat midurethral sling procedures had almost two times the odds of SUI treatment failure but greater improvement in symptom effect on QOL than did those undergoing a primary midurethral sling procedure. This information can help counsel patients regarding their expectations of repeat midurethral sling surgery for recurrent SUI .

Level of evidence: II.

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Comment in

  • Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures.
    Leone Roberti Maggiore U, Venturini PL, Ferrero S. Leone Roberti Maggiore U, et al. Obstet Gynecol. 2013 May;121(5):1108. doi: 10.1097/AOG.0b013e31828fc2a9. Obstet Gynecol. 2013. PMID: 23635753 No abstract available.
  • In reply.
    Richter HE, Parden AM, Gleason JL. Richter HE, et al. Obstet Gynecol. 2013 May;121(5):1108-1109. doi: 10.1097/AOG.0b013e31828fc680. Obstet Gynecol. 2013. PMID: 23635754 Free PMC article. No abstract available.

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