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Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures.
Obstet Gynecol. 2013 Feb; 121(2 Pt 1):273-8.OG

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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23344276

Citation

Parden, Alison M., et al. "Incontinence Outcomes in Women Undergoing Primary and Repeat Midurethral Sling Procedures." Obstetrics and Gynecology, vol. 121, no. 2 Pt 1, 2013, pp. 273-8.
Parden AM, Gleason JL, Jauk V, et al. Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures. Obstet Gynecol. 2013;121(2 Pt 1):273-8.
Parden, A. M., Gleason, J. L., Jauk, V., Garner, R., Ballard, A., & Richter, H. E. (2013). Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures. Obstetrics and Gynecology, 121(2 Pt 1), 273-8. https://doi.org/http://10.1097/AOG.0b013e31827c5de7
Parden AM, et al. Incontinence Outcomes in Women Undergoing Primary and Repeat Midurethral Sling Procedures. Obstet Gynecol. 2013;121(2 Pt 1):273-8. PubMed PMID: 23344276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incontinence outcomes in women undergoing primary and repeat midurethral sling procedures. AU - Parden,Alison M, AU - Gleason,Jonathan L, AU - Jauk,Victoria, AU - Garner,Rachel, AU - Ballard,Alicia, AU - Richter,Holly E, PY - 2013/1/25/entrez PY - 2013/1/25/pubmed PY - 2013/4/6/medline SP - 273 EP - 8 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 121 IS - 2 Pt 1 N2 - 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. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/23344276/Incontinence_outcomes_in_women_undergoing_primary_and_repeat_midurethral_sling_procedures_ L2 - http://dx.doi.org/10.1097/aog.0b013e31827c5de7 DB - PRIME DP - Unbound Medicine ER -