Obstetrics & Gynecology

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

Collapse Box

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

Login

 

Looking for ABOG articles? Visit our ABOG MOC II collection. The selected Green Journal articles are free through the end of the calendar year.

ACOG MEMBER SUBSCRIPTION ACCESS

If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.

Article Tools

Share

Article Level Metrics