Self-reported urinary continence outcomes for repeat midurethral synthetic sling placement

Abstract

Objective: To evaluate our experience with tension-free transvaginal tape (TVT) placement for the management of stress urinary incontinence (SUI) in women who had previously undergone a failed midurethral synthetic sling (MUS) procedure. Materials and Methods: Ten women underwent retropubic TVT insertion for continued or recurrent SUI following a prior MUS procedure. No attempt was made to remove the previously placed sling at the time of surgery. A retrospective chart review was performed to obtain perioperative and follow-up patient information. Post-operatively, each patient completed a mailed incontinence questionnaire to assess self-reported urinary continence outcomes. Results: All 10 women were available for follow-up at a mean period of 16 months (range 6 to 33). Four of the 10 patients achieved complete continence, and another three patients reported significantly improved continence and quality of life. Three women stated that their continence did not improve. Conclusions: TVT placement may be a viable option for the management of women with persistent or recurrent SUI following an initial MUS procedure.

Repeat midurethral sling treatment for prior midurethral sling failure

“…Moore et al [15] reported just five patients and concluded the TOT sling did not provide a large enough angle of support or enough urethral kinking to provide continence in patients with ISD. Therefore, a TVT sling was a viable option for a prior failed TOT [14]. Villet et el.…”

“…Preoperative evaluation has included a comprehensive medical history, physical examination (e.g., stress test, Bonney and Q-tip test), neurological evaluation, urinalysis, urine culture, pad test, uroflowmetry, post-void residual urine measurement, voiding diary and complete urodynamic study, and even a cystoscopic examination [14][15][16][17]. Before a repeat MUS procedure, conservative treatment, such as pelvic floor exercises or periurethral collagen injections and tape readjustment, was provided in some studies [13][14][15][16]. Moore et al [15] provided the option of pelvic floor exercises and collagen injections, but patients eventually returned to a repeat TVT surgical intervention when they had no improvement.…”

“…However, as many as 5-20% of patients experience failed sling treatment. Recently, several possible salvage options have been published, including pelvic floor rehabilitation, placement of an artificial urethral sphincter [6,7], periurethral injection of bulking agents [7], colposuspension [8,9], readjustment ( placation, shortening, or retensioning) of previously implanted tape [10][11][12][13], and a repeat MUS procedure ( TVT/TVT-O/TOT) [14][15][16][17][18][19][20][21][22]. The MUS procedure has been reported to be successful in treating recurrent/persistent SUI no matter which type of procedure had failed previously.…”

Safety considerations for synthetic sling surgery

“…9,261 In addition, the qualifiers persistent or de novo 261 were often used. De novo OAB, indicating the occurrence of OAB after sling surgery, was reported in 0-48% of patients in various studies (REFS 17,18,20,26,39,(46)(47)(48)(50)(51)(52)(53)55,(57)(58)(59)61,62,66,67,70,(73)(74)(75)(76)(77)79,83,87,88,91,92,96,97,99,140,152,153,155,157,159,161,163,164,(166)(167)(168)(170)(171)…”

“…9,110,143 In studies of effectiveness and safety, pain was mostly divided into perioperative pain and pain lasting more than 6 weeks. Perioperative pain has been reported in up to 33% of patients, 252 occurring more frequently after implantation of TOT slings than RP slings, 331 and chronic pain (of any definition) has been reported in 0-31% of patients (REFS 17,18,20,30,39,47,48,53,58,59,(61)(62)(63)66,69,70,73,76,79,82,(89)(90)(91)95,98,99,140,152,155,159,164,167,168,(171)(172)(173)(174)177,(180)(181)(182)185,208,…”