IS REPEAT TRANSOBTURATOR MIDURETHRAL SLING FEASIBLE FOR RECURRENT OR PERSISTENT STRESSINCONTINENCE?
J. SON1, D. SOHN 2,S. JANG 1, J. LEE 1, D. CHO 1;
1Bundang Jesaeng Hosp., Seongnam, Korea, Republic of,2St. Mary's Hosp., The Catholic Univ. of Ko, Seoul, Korea,Republic of.
Introduction: Mid urethral sling(MUS) is the gold standard in stress urinary incontinence treatment(1). However, 5-20% of treated patients experience surgical failurewith recurrent or persistent stress urianary incontinence (2, 3).Treatment options for failure after MUS procedure are retropubicsuspension, urethral bulking agents, pubovaginal sling, shortening ofthe pre-implanted tape, artificial urethral sphincter or repeat MUS.Among them, repeat MUS is an attractive option for primary MUSfailure, since the MUS procedure is simple and has a high successrate. But, the value of repeat MUS after failed primary MUS is notgenerally accepted. So, further accumulation of surgical data isnecessary.
Objective: The aims of present study is toevaluate outcomes of repeat transobturator MUS and to find out itsfeasibility for recurrent or persistent stress incontinence.
Methods:We reviewed medical records of 112 patients who underwenttransobturator MUS procedure from January 2010 to December 2014 atour institute. They were evaluated preoperatively with an interviewabout medical and surgical history and symptoms, a physicalexamination including a provocation test on lithotomy and standingposition, and urodynamic study. Our criteria to choose thetransobturator MUS as a surgical treatment were the confirmation ofmidurethra hypermobility and urine leakage on provocation test andthe objective rule-out of intrinsic sphincter deficiency and detrusorunderactivity on urodynamic study. For patients that did not meet thecriteria, we chose the other surgical methods such as pubovaginalsling or readjustable sling. Excluding 17 patients that were lost tofollow-up before postoperative 1 year, we analyzed 15 patients of therepeat transobturator MUS and 80 patients of the primarytransobturator MUS.
Results: The mean age was 62.4 years(range 35-68) in the repeat transobturator MUS group and 59.8 years(range 33-75) in the primary transobturator MUS. The mean time to therepeat transobturator MUS was 20.3 months (range 3-36). The repeattransobturator MUS was placed without removal of the previous MUS.Surgical results were evaluated postoperatively at 1month, 6month andmore than 12 months. At more than 12 months, subjective cure rate andsubjective improvement rate in the repeat transobturator MUS groupwere not significantly different from the primary transobturator MUSgroup (repeat vs primary: 73.3% vs 81.3%, p=0.63; 86.6% vs 92%,p=0.51) and objective cure rate also showed no statisticallysignificant difference between two groups( 80% vs 88.8%, P=0.69).There was no statistically significant difference in de novo urgencybetween two groups (13.3% vs 13.8%, p=0.94). There was only one minormesh extrusion in the primary transobturator MUS group.
Conclusions:In the matter of cure rate, improvement rate and complication rate,the repeat transobturator MUS is feasible for recurrent or persistentstress incontinence which is confirmed to have the urethrahypermobility through the close preoperative evaluation.
References:1. The Cochrane Database of Systematic Reviews, no. 7, ArticleIDCD006375, 2015.2. Curr Opin Obstet Gynecol. 2004;16:399. 3. ObstetGynecol. 2004;104:1259.