A recent study published in Neurourology and Urodynamics, Objective outcome and quality-of-life assessment in women with repeat incontinence surgery, evaluates outcomes after repeat surgery for stress urinary incontinence (SUI). This small study included women who underwent a midurethral tape after failed Burch colposuspension or failed midurethal tape. The investigators evaluated objective and subjective cure rates and used validated questionnaires, following patients for 11 years.
Of the 52 women that underwent repeat incontinence surgery during the study period, (75%) attended and completed the questionnaires; 23 women (70%) had a clinical examination. Subjective cure was 67%, objective cure was 65% and subjective success according to PGI-I was 78%, with no significant differences between groups. No erosions of suture or tape material into the bladder, urethra, or vagina were seen. Two women had received a third anti-incontinence operation with TVT after failed tape after failed Burch, and were continent at follow-up. Two women with tape after colposuspension required division of the tape and both were continent at the time of follow-up. The patients in this study had a 70% OAB rate at follow-up. The authors explain this incidence as a contribution of de novo OAB due to age, or over-reporting by the patients since only two showed DO on urodynamics. The small sample size is a major limitation of this study. However, results are consistent with previous published reports.
A systematic review by Nikolopoulos et al (2) showed that repeat midurethral sling procedures have a pooled success rate of 66.2%, which is in agreement with these results. That systematic review showed that success rates of the transobturator approach are lower than retropubic procedures. The meta-analysis by Agur et al showed no statistically significant difference between retropubic TVT and transobturator TVT in the patient-reported improvement or objective cure/improvement.
Article by the Publication and Communications Committee
Objective outcome and quality-of-life assessment in women with repeat incontinence surgery. Ulrich D, Bjelic-Radisic V, Grabner K, Avian A, Trutnovsky G, Tamussino K, Aigmüller T. Neurourol Urodyn. 2016 Sep 27. doi: 10.1002/nau.23144
Nikolopoulos KI, Betschart C, Doumouchtsis SK. The surgical management of recurrent stress urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2015 Jun;94(6):568-76. doi: 10.1111/aogs.12625.
Agur W, Riad M, Secco S, Litman H, Madhuvrata P, Novara G, Abdel-Fattah M. Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials. Eur Urol. 2013 Aug;64(2):323-36. doi: 10.1016/j.eururo.2013.04.034.