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Management of recurrent stress urinary incontinence after burch and sling procedures.
Neurourol Urodyn. 2016 Mar; 35(3):344-8.NU

Abstract

AIMS

To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures.

METHODS

We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated.

RESULTS

Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%), and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (P < 0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (P < 0.0001).

CONCLUSION

In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment.

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Authors+Show Affiliations

Zimmern PE
UT Southwestern Medical Center, Dallas, Texas.
Gormley EA
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Stoddard AM
New England Research Institute, Watertown, Massachusetts.
Lukacz ES
University of California, San Diego, California.
Sirls L
Beaumont Hospital, Royal Oak, Michigan.
Brubaker L
Loyola University, Maywood, Illinois.
Norton P
University of Utah, Salt Lake City, Utha.
Oliphant SS
University of Arkansas, Little Rock, Arkansas.
Wilson T
University of Alabama at Brimingham, Birmingham, Alabama.

MeSH

AdultAutograftsDisease-Free SurvivalFasciaFemaleHumansKaplan-Meier EstimateMiddle AgedProsthesis DesignRandomized Controlled Trials as TopicRecurrenceReoperationRisk FactorsSuburethral SlingsTime FactorsTreatment OutcomeUrinary Incontinence, StressUrologic Surgical Procedures

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25598512

Citation

Zimmern, Philippe E., et al. "Management of Recurrent Stress Urinary Incontinence After Burch and Sling Procedures." Neurourology and Urodynamics, vol. 35, no. 3, 2016, pp. 344-8.
Zimmern PE, Gormley EA, Stoddard AM, et al. Management of recurrent stress urinary incontinence after burch and sling procedures. Neurourol Urodyn. 2016;35(3):344-8.
Zimmern, P. E., Gormley, E. A., Stoddard, A. M., Lukacz, E. S., Sirls, L., Brubaker, L., Norton, P., Oliphant, S. S., & Wilson, T. (2016). Management of recurrent stress urinary incontinence after burch and sling procedures. Neurourology and Urodynamics, 35(3), 344-8. https://doi.org/10.1002/nau.22714
Zimmern PE, et al. Management of Recurrent Stress Urinary Incontinence After Burch and Sling Procedures. Neurourol Urodyn. 2016;35(3):344-8. PubMed PMID: 25598512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of recurrent stress urinary incontinence after burch and sling procedures. AU - Zimmern,Philippe E, AU - Gormley,E Ann, AU - Stoddard,Anne M, AU - Lukacz,Emily S, AU - Sirls,Larry, AU - Brubaker,Linda, AU - Norton,Peggy, AU - Oliphant,Sallie S, AU - Wilson,Tracey, Y1 - 2015/01/16/ PY - 2014/07/24/received PY - 2014/10/29/accepted PY - 2017/03/01/pmc-release PY - 2015/1/20/entrez PY - 2015/1/20/pubmed PY - 2016/12/15/medline KW - female KW - recurrent stress urinary incontinence KW - surgical treatment SP - 344 EP - 8 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 35 IS - 3 N2 - AIMS: To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures. METHODS: We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated. RESULTS: Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%), and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (P < 0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (P < 0.0001). CONCLUSION: In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/25598512/Management_of_recurrent_stress_urinary_incontinence_after_burch_and_sling_procedures_ DB - PRIME DP - Unbound Medicine ER -