Stress urinary incontinence (SUI) in women is common, and anti-incontinence surgery can effectively cure SUI in more than 90% of women. The durability of effective anti-incontinence surgery can last for more than 10 years. However, part of women might have recurrence of bothersome SUI needing repeat procedure. This study aimed to investigate the risk factors that may predict the SUI recurrence needing repeat anti-incontinence surgery within 5 years after prior surgery.

A total of 560 women with videourodynamic study (VUDS) proven genuine SUI (GSI) with or without pelvic organ prolapse who underwent anti-incontinence surgery with or without concomitant anterior colporrhaphy and had been followed up for more than 5 years were enrolled in this study. All patients had normal detrusor contractility, intrinsic sphincter deficiency, and were free of detrusor areflexia or acontractile in VUDS. If patients had difficulty in urination or urinary retention after anti-incontinence, VUDS was performed and transvaginal urethrolysis was undertaken to relieve the urethral obstruction. All patients were free of SUI and voiding difficulty on discharge. During the follow-up period, patients were followed every one year, urethral sling revision without removal if sling erosion was detected. When patients complained recurrence of SUI greatly bothered their quality of life, repeat anti-incontinence procedure will be performed after VUDS confirming ISD without other complicated lower urinary tract dysfunction. Patients with recurrence of SUI needing repeat procedure within 5 years were analyzed for their baseline VUDS findings, clinical demographics, and perioperative procedure, and the risk factors for repeat procedure were investigated.

Among the 560 women, recurrence of SUI needing repeat procedure within 5 years was noted in 27 (4.8%). The baseline demographic data are shown in Table 1. Patients with parity of more than 5, VUDS proven detrusor underactivity, a low maximum flow rate (Qmax), small voided volume, a low voiding efficiency, and low bladder outlet obstruction index at baseline, received postoperative transvaginal urethrolysis, and postoperative erosive sling revision were noted to have significantly higher rats of SUI recurrence needing repeat sling surgery.  Among the patients who received retropubic pubovaginal sling procedure, suburethral transobturtator (TOT) sling, and combined anterior colporrhaphy and suburethral sling, TOT sling procedure possessed a lower long-term success rate  (Figure 1).

Women with baseline lower Qmax usually need abdominal pressure to achieve a complete bladder emptying. Doctors performing anti-incontinence surgery for these patients might not as tight as performing the procedure for women with normal or high Qmax. Although women with a lower bladder outlet resistance after anti-incontinence surgery might urinate efficiently after operation, the long-term durability will decrease because the urethral resistance will decrease with ageing. The same situation also occurs in women who received postoperative urethrtolyisis or sling revision due to erosion. These procedures lessen urethral resistance and increase the risk of SUI recurrence needing repeat procedure.

Recurrence rate of SUI needing repeat anti-incontinence surgery within 5 years is low in women with VUDS proven GSI. A low Qmax at baseline VUDS, postoperative difficult urination needing transvaginal urethrolysis, and sling erosion receiving sling revision are risks factors for SUI recurrence needing repeat procedure. Among the different anti-incontinence surgical procedures, suburethral TOT sling had a low long-term success rate.