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Concurrent midurethral sling excision or lysis at the time of repeat sling for treatment of recurrent or persistent stress urinary incontinence.
Int Urogynecol J. 2018 02; 29(2):285-290.IU

Abstract

INTRODUCTION AND HYPOTHESIS

Limited evidence guides operative technique in primary midurethral sling (MUS) lysis or excision at the time of repeat sling placement for persistent or recurrent stress urinary incontinence (SUI). Our objective is to compare subjective improvement in patients undergoing repeat MUS placement with and without concurrent primary sling lysis or removal.

METHODS

This was a retrospective cohort study with a prospective survey of patients who underwent two MUS placements for SUI at a single institution from January 1996 to December 2015. After patient identification, the electronic record was queried for demographic and perioperative data. Subjects then completed the Urogenital Distress Index, (UDI-6), Incontinence Severity Index (ISI), and the Incontinence Impact Questionnaire (IIQ-7). Subjects were also asked if they would choose to undergo repeat MUS surgery again.

RESULTS

Sixty-one patients were included. 17 out of 61 (28%) underwent concomitant primary sling lysis or excision, and 44 out of 61 (72%) did not. Fifty-seven percent (n = 35) completed the survey. Of the respondents, the median ISI score was 4 (1-8), with no difference between groups; 14 out of 35 (40%) reported the presence of bothersome urge incontinence, 11 out of 35 (31%) reported bothersome stress urinary incontinence, and 8 out of 35 (23%) reported symptoms of voiding dysfunction, with no difference between groups. 57% of patients (20 out of 35) would undergo repeat MUS placement again.

CONCLUSIONS

In a small cohort, concurrent excision of the primary sling at the time of repeat MUS did not improve subjective outcomes. Many patients reported urinary urgency and voiding symptoms, and only about half of patients would choose to undergo the surgery again if given the choice.

Authors+Show Affiliations

Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. steeles5@ccf.org.Department of Obstetrics and Gynecology, Division of Urogynecology, University of Utah, Salt Lake City, UT, USA.Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28580496

Citation

Steele, Sarah E., et al. "Concurrent Midurethral Sling Excision or Lysis at the Time of Repeat Sling for Treatment of Recurrent or Persistent Stress Urinary Incontinence." International Urogynecology Journal, vol. 29, no. 2, 2018, pp. 285-290.
Steele SE, Hill AJ, Unger CA. Concurrent midurethral sling excision or lysis at the time of repeat sling for treatment of recurrent or persistent stress urinary incontinence. Int Urogynecol J. 2018;29(2):285-290.
Steele, S. E., Hill, A. J., & Unger, C. A. (2018). Concurrent midurethral sling excision or lysis at the time of repeat sling for treatment of recurrent or persistent stress urinary incontinence. International Urogynecology Journal, 29(2), 285-290. https://doi.org/10.1007/s00192-017-3385-5
Steele SE, Hill AJ, Unger CA. Concurrent Midurethral Sling Excision or Lysis at the Time of Repeat Sling for Treatment of Recurrent or Persistent Stress Urinary Incontinence. Int Urogynecol J. 2018;29(2):285-290. PubMed PMID: 28580496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concurrent midurethral sling excision or lysis at the time of repeat sling for treatment of recurrent or persistent stress urinary incontinence. AU - Steele,Sarah E, AU - Hill,Audra J, AU - Unger,Cecile A, Y1 - 2017/06/03/ PY - 2017/02/12/received PY - 2017/05/17/accepted PY - 2017/6/6/pubmed PY - 2018/9/20/medline PY - 2017/6/6/entrez KW - Midurethral sling KW - Midurethral sling excision KW - Midurethral sling revision KW - Recurrent stress urinary incontinence KW - Stress urinary incontinence SP - 285 EP - 290 JF - International urogynecology journal JO - Int Urogynecol J VL - 29 IS - 2 N2 - INTRODUCTION AND HYPOTHESIS: Limited evidence guides operative technique in primary midurethral sling (MUS) lysis or excision at the time of repeat sling placement for persistent or recurrent stress urinary incontinence (SUI). Our objective is to compare subjective improvement in patients undergoing repeat MUS placement with and without concurrent primary sling lysis or removal. METHODS: This was a retrospective cohort study with a prospective survey of patients who underwent two MUS placements for SUI at a single institution from January 1996 to December 2015. After patient identification, the electronic record was queried for demographic and perioperative data. Subjects then completed the Urogenital Distress Index, (UDI-6), Incontinence Severity Index (ISI), and the Incontinence Impact Questionnaire (IIQ-7). Subjects were also asked if they would choose to undergo repeat MUS surgery again. RESULTS: Sixty-one patients were included. 17 out of 61 (28%) underwent concomitant primary sling lysis or excision, and 44 out of 61 (72%) did not. Fifty-seven percent (n = 35) completed the survey. Of the respondents, the median ISI score was 4 (1-8), with no difference between groups; 14 out of 35 (40%) reported the presence of bothersome urge incontinence, 11 out of 35 (31%) reported bothersome stress urinary incontinence, and 8 out of 35 (23%) reported symptoms of voiding dysfunction, with no difference between groups. 57% of patients (20 out of 35) would undergo repeat MUS placement again. CONCLUSIONS: In a small cohort, concurrent excision of the primary sling at the time of repeat MUS did not improve subjective outcomes. Many patients reported urinary urgency and voiding symptoms, and only about half of patients would choose to undergo the surgery again if given the choice. SN - 1433-3023 UR - https://www.unboundmedicine.com/medline/citation/28580496/Concurrent_midurethral_sling_excision_or_lysis_at_the_time_of_repeat_sling_for_treatment_of_recurrent_or_persistent_stress_urinary_incontinence_ L2 - https://dx.doi.org/10.1007/s00192-017-3385-5 DB - PRIME DP - Unbound Medicine ER -