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Efficacy of Repeat Midurethral Sling for Persistent or Recurrent Stress Urinary Incontinence

A Fellows Pelvic Research Network Study

Smithling, Katelyn R. MD*; Adams-Piper, Emily E. MD; Tran A, Alexis M. MD; Davé, Bhumy A. BA, MD§; Chu, Christine M. MD; Chan, Robert C. MD; Antosh, Danielle D. MD; Gutman, Robert E. MD*

Female Pelvic Medicine & Reconstructive Surgery: July 11, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000598
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Objective The objective of this study is to compare quality of life and success rates of repeat midurethral slings (RMUS) using retropubic (RP) and transobturator (TO) routes.

Materials and Methods Multicenter retrospective cohort with prospective follow-up of patients undergoing RMUS from 2003 to 2016. Prospective Urinary Distress Inventory (UDI-6) and Patient Global Impression of Improvement (PGI-I) were collected by phone. Primary outcome was success of repeat sling by approach (RP vs TO), defined as responses of no to UDI-6 number 3 and very much better or much better on PGI-I.

Results A total of 122 patients prospectively completed UDI-6. Average ± SD time to failure after initial sling was 51.6 ± 56.1 months; mean follow-up after repeat sling was 30.7 months. Route of initial sling was RP 30.3%, TO 49.2%, and minisling 16.4%. Of the patients, 55.8% met our success definition following RMUS. About 71.3% were very much better or much better on PGI-I, and 30.3% reported stress urinary incontinence (SUI) on UDI-6. Of the RMUS, 73.8% were RP versus 26.2% TO.

There was no difference in success between repeat RP and TO routes (53.3% versus 63.3%, P = 0.34), nor for individual components: PGI-I response of very much better or much better (68.9% vs 78.1%), UDI-6 total score (25.9 vs 22.7, P = 0.29), or SUI on UDI-6 number 3 (32.2% vs 25.0%, P = 0.45), although the predetermined sample size was not met. No predictors of success or failure of RMUS were identified.

Conclusions Majority of patients are very much better or much better after RMUS, although 30% still report bothersome SUI. No difference in success was observed between RP and TO RMUS.

From the *Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Georgetown University/MedStar Washington Hospital Center, Washington, DC;

Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, Irvine, Orange, CA;

Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Chicago, Chicago, IL;

§Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL;

Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA; and

Division of Urogynecology, Houston Methodist Hospital, Houston, TX.

Correspondence: Katelyn R. Smithling, MD, 759 Chestnut St, Room S1681, Springfield, MA 01199. katelyn.smithling@gmail.com.

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