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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

doi: 10.1097/AOG.0b013e31827c5de7
Original Research

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

Women undergoing repeat midurethral sling procedures have higher failure rates but greater improvement in symptom-specific effect on quality of life than do women undergoing primary midurethral sling procedures.

Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, Alabama.

Corresponding author: Holly E. Richter, PhD, MD, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233; e-mail: hrichter@uabmc.edu.

Partially funded by National Institute of Diabetes and Digestive and Kidney Diseases 2K24-DK068389 to Holly E. Richter.

The authors thank Alice A. Howell, RN, BSN, CCRC, for protocol implementation of this project.

Presented at the American Urogynecologic Society meeting, October 3–6, 2012, Chicago, Illinois.

Financial Disclosure Dr. Richter has been a consultant to Astellas, GlaxoSmithKline, Uromedica, IDEO, Pfizer, and Xanodyne. She has received research grants from Pelvalon, Astellas, Warner Chilcott, University of California/Pfizer, and Pfizer. The other authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists