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Risk factors for failure of repeat midurethral sling surgery for recurrent or persistent stress urinary incontinence.
Int Urogynecol J. 2016 Jun; 27(6):923-31.IU

Abstract

INTRODUCTION AND HYPOTHESIS

To study the outcomes following repeat midurethral sling (MUS) surgery in patients with persistent or recurrent stress urinary incontinence after failure of primary MUS surgery and risk factors for surgical failure.

METHODS

The medical records of 24 patients who underwent repeat MUS surgery at a single tertiary center from January 2004 to February 2014 were reviewed. The types of MUS used for the repeat surgey were transobturator, retropubic and single incision slings. Objective cure was defined as no demonstrable involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction observed during filling cystometry, and subjective cure was defined as a negative response to Urogenital Distress Inventory six (UDI-6) question 3 during follow-up between 6 months and 1 year postoperatively. The change in the inclination angle between the urethra and pubic axis was measured with introital ultrasonography and the cotton swab test performed.

RESULTS

The objective and subjective cure rates were 79.2 % and 75 %, respectively. There were no differences in demographics between the patients with failure of surgery and those with successful surgery. Significant independent risk factors for failure of repeat MUS surgery were a change in cotton swab angle at rest and straining of <30° (OR 4.6, 95 % CI 2.5 - 7.9°), a change in inclination angle of <30° (OR 4.6, 95 % CI 2.5 - 7.9°), intrinsic sphincter deficiency (OR 3.4, 95 % CI 1.8 - 6.1) and a mean urethral closure pressure of <60 cm H2O (OR 2.9, 95 % CI 1.5 - 4.5). In one patient the bladder was perforated.

CONCLUSIONS

Repeat MUS surgery is safe and has a good short-term success rate, both objectively and subjectively, with independent risk factors for failure related to bladder neck hypomobility and poor urethral function.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Keelung Medical Center, Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan, 204, Republic of China. 2378@cgmh.org.tw. Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China. 2378@cgmh.org.tw. School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. 2378@cgmh.org.tw.Department of Obstetrics and Gynecology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.Department of Obstetrics and Gynecology, Kuching Specialist Hospital, Sarawak, Malaysia.Department of Obstetrics and Gynecology, Keelung Medical Center, Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan, 204, Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26700103

Citation

Lo, Tsia-Shu, et al. "Risk Factors for Failure of Repeat Midurethral Sling Surgery for Recurrent or Persistent Stress Urinary Incontinence." International Urogynecology Journal, vol. 27, no. 6, 2016, pp. 923-31.
Lo TS, Pue LB, Tan YL, et al. Risk factors for failure of repeat midurethral sling surgery for recurrent or persistent stress urinary incontinence. Int Urogynecol J. 2016;27(6):923-31.
Lo, T. S., Pue, L. B., Tan, Y. L., & Wu, P. Y. (2016). Risk factors for failure of repeat midurethral sling surgery for recurrent or persistent stress urinary incontinence. International Urogynecology Journal, 27(6), 923-31. https://doi.org/10.1007/s00192-015-2912-5
Lo TS, et al. Risk Factors for Failure of Repeat Midurethral Sling Surgery for Recurrent or Persistent Stress Urinary Incontinence. Int Urogynecol J. 2016;27(6):923-31. PubMed PMID: 26700103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for failure of repeat midurethral sling surgery for recurrent or persistent stress urinary incontinence. AU - Lo,Tsia-Shu, AU - Pue,Leng Boi, AU - Tan,Yiap Loong, AU - Wu,Pei-Ying, Y1 - 2015/12/23/ PY - 2015/09/16/received PY - 2015/11/23/accepted PY - 2015/12/25/entrez PY - 2015/12/25/pubmed PY - 2017/8/31/medline KW - Cotton swab test KW - Midurethral sling KW - Recurrent KW - Stress urinary incontinence KW - Ultrasound SP - 923 EP - 31 JF - International urogynecology journal JO - Int Urogynecol J VL - 27 IS - 6 N2 - INTRODUCTION AND HYPOTHESIS: To study the outcomes following repeat midurethral sling (MUS) surgery in patients with persistent or recurrent stress urinary incontinence after failure of primary MUS surgery and risk factors for surgical failure. METHODS: The medical records of 24 patients who underwent repeat MUS surgery at a single tertiary center from January 2004 to February 2014 were reviewed. The types of MUS used for the repeat surgey were transobturator, retropubic and single incision slings. Objective cure was defined as no demonstrable involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction observed during filling cystometry, and subjective cure was defined as a negative response to Urogenital Distress Inventory six (UDI-6) question 3 during follow-up between 6 months and 1 year postoperatively. The change in the inclination angle between the urethra and pubic axis was measured with introital ultrasonography and the cotton swab test performed. RESULTS: The objective and subjective cure rates were 79.2 % and 75 %, respectively. There were no differences in demographics between the patients with failure of surgery and those with successful surgery. Significant independent risk factors for failure of repeat MUS surgery were a change in cotton swab angle at rest and straining of <30° (OR 4.6, 95 % CI 2.5 - 7.9°), a change in inclination angle of <30° (OR 4.6, 95 % CI 2.5 - 7.9°), intrinsic sphincter deficiency (OR 3.4, 95 % CI 1.8 - 6.1) and a mean urethral closure pressure of <60 cm H2O (OR 2.9, 95 % CI 1.5 - 4.5). In one patient the bladder was perforated. CONCLUSIONS: Repeat MUS surgery is safe and has a good short-term success rate, both objectively and subjectively, with independent risk factors for failure related to bladder neck hypomobility and poor urethral function. SN - 1433-3023 UR - https://www.unboundmedicine.com/medline/citation/26700103/Risk_factors_for_failure_of_repeat_midurethral_sling_surgery_for_recurrent_or_persistent_stress_urinary_incontinence_ L2 - https://dx.doi.org/10.1007/s00192-015-2912-5 DB - PRIME DP - Unbound Medicine ER -