Repeat sling procedures for recurrent stress urinary incontinence: Effectiveness and risk factors

This study examined the effectiveness of repeat vaginal sling procedures as well as possible risk factors associated with negative surgical outcomes.

Researchers concluded that a repeat vaginal sling surgery is an effective treatment option for women who continue to experience incontinence after the first sling procedure.

Stress urinary incontinence (SUI) can lead to bothersome symptoms that affect quality of life and challenge everyday activities. Over the past decade, minimally invasive vaginal sling procedures have been developed to treat SUI. Previous studies have found them to be an effective treatment option for women with SUI. However, a small proportion of women may continue to experience urinary symptoms after surgery. In these cases, a second sling procedure can be undertaken to manage recurrent symptoms. This study evaluated the outcomes of repeat sling procedures and assessed risk factors associated with surgical failure.

Urinary symptoms of 24 women undergoing a repeat sling procedure were recorded for an average of four years. The type of sling techniques used were tension-free vaginal tape (TVT), transobturator tape (TOT) and MiniArc, a single-incision mini-sling. Vaginal sling and bladder position were assessed by an ultrasound exam at various time points.

After the repeat procedure, 19 of the women (79%) recovered urine continence, while 5 of the women (21%) continued to experience SUI.

There were no significant differences in demographic factors (such as age, body mass index, hospital stay or surgical technique) between women who experienced failure of repeat surgery and those with successful surgery.

As identified by ultrasound, women with good mobility of the bladder base and function of the urine duct were significantly more likely to experience a successful surgery. This was true for first and for repeat sling procedures.

Researchers concluded that repeat sling procedures are safe and effective in treating recurrent urinary symptoms following the first procedure. Risk factors associated with surgical failure were poor bladder base mobility and poor urethral function.

Larger studies are needed to confirm the preliminary results of this study.