Skip Navigation LinksHome > February 2013 - Volume 121 - Issue 2, PART 1 > Incontinence Outcomes in Women Undergoing Primary and Repeat...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31827c5de7
Original Research

Incontinence Outcomes in Women Undergoing Primary and Repeat Midurethral Sling Procedures

Parden, Alison M. MD; Gleason, Jonathan L. MD; Jauk, Victoria MPH; Garner, Rachel MD; Ballard, Alicia MD; Richter, Holly E. PhD, MD

Pearls of Exxcellence
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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

© 2013 The American College of Obstetricians and Gynecologists

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