Second time around: Repeated vaginal sling surgery

This study examined the long-term effectiveness of repeated (second) vaginal sling surgery in women with continued urinary incontinence.

Researchers concluded that a repeat sling procedure is an effective treatment option for women after an unsuccessful first surgery.

Vaginal sling procedures are currently the most common type of surgery used to help control stress urinary incontinence. Studies have found these sling procedures to be an effective long-term treatment option. However, some women continue to experience incontinence after a vaginal sling procedure. Repeated sling surgery is often offered to such women. However, the long-term benefits of a repeat sling procedure in treating chronic stress urinary incontinence is still under exam.

Surgery outcomes of 102 women who underwent their first vaginal sling procedure were compared to those of 53 women who underwent a repeat vaginal sling procedure. The average time between first and second surgery was approximately two years (with a wide range of 1.6 months to 4.3 years). The study followed outcomes for over four years after surgery.

The overall success rate of the surgery was similar for both groups (first and second surgery). Urinary symptoms improved in 77% of women treated with their first sling procedure and in 70% of women treated with a repeat sling procedure.

Women treated with a repeat sling procedure showed greater improvements in symptom severity, compared to women after their first surgery. Significantly greater improvements in quality of life, sexual function, and positive psychological impact were also noted among second surgery patients. However, women with severe stress urinary incontinence (grade 3) were seven-times more likely to relapse after a repeated sling procedure.

The researchers concluded that repeated vaginal sling surgery is an effective treatment option for women who continue to experience urinary incontinence after a primary sling procedure. However, researchers advise that a repeat procedure may be unsuccessful in patients with very severe urinary incontinence.