A new study by University of Alabama at Birmingham (UAB) researchers published in the February 2013 issue of Obstetrics and Gynecology found that women who have unsuccessful midurethral sling surgery for stress urinary incontinence and then undergo a second midurethral sling surgery see more quality-of-life symptom improvement than women who undergo only a first procedure.
Stress urinary incontinence, the involuntary leakage of urine with increases in abdominal pressure, affects up to 35 percent of women. A midurethral sling is considered the gold standard for stress urinary incontinence treatment, with more than 103,000 performed annually. The success rates for these procedures at one year post-surgery range from 77 to 90 percent, but that still leaves an estimated 23,600 women having a recurrence of stress urinary incontinence after surgery.
Many women who have an unsuccessful first surgery do not elect to have a second; they move onto other methods of addressing the problem.
The goal of the new UAB study was to assess and compare continence outcomes of women undergoing a first and repeat midurethral sling procedure. It was also designed to compare lower urinary tract symptoms, patient satisfaction and patient impression of improvement of their stress urinary incontinence. Looking at previous small studies, the UAB research team hypothesized that women undergoing a repeat procedure would have outcomes similar to those who experienced a successful procedure the first time.
"The optimal management of recurrent stress urinary incontinence after a midurethral sling procedure is unknown," said the study's senior author, Holly E. Richter, Ph.D., M.D., professor of obstetrics and gynecology, holder of the J. Marion Sims Endowed Chair in Obstetrics and Gynecology and director of the UAB Division of Urogynecology and Pelvic Reconstructive Surgery. "There has been little published data on outcomes of repeat midurethral sling procedures for stress urinary incontinence. The largest study before this was a cohort of 77 patients. Despite this limited data, the most common management for recurrent stress urinary incontinence is a repeat midurethral sling procedure."
The team looked at 1,316 patients who underwent midurethral sling procedures from April 1, 2006, to Dec. 31, 2009, at UAB. Of those patients, 135 (10.2 percent) had undergone prior procedures. Women in the study group were defined as those who had documentation of a prior procedure; women in the control group were defined as those who had no history of having had a prior procedure. Minimum follow-up was 12 months. All eligible patients were mailed six different questionnaires assessing satisfaction and symptoms after surgery, which included questions on measures of satisfaction and patient impression of improvement.