Midurethral Tape and Repeat Surgery for Stress Incontinence: Is the 2nd Time the Charm?
BACKGROUND AND PURPOSE:
Up to 15% of women undergoing surgery for SUI will still have SUI symptomatology requiring further treatment
There is lack of data on quality-of-life (QoL) as an outcome measure for repeat surgery for stress urinary incontinence (SUI)
Ulrich et al. (Neurourology and Urodynamics, 2016) sought to assess the efficacy of midurethral tape for failed initial SUI surgery by measuring objective outcomes, QofL, patient satisfaction and sexual health in women who had repeat surgery for SUI
Retrospective cohort study of women who had placement of midurethral tape following a failed Burch or midurethral tape procedure for SUI (1999-2105)
Urogynecological and urodynamics were performed
Objective cure was assessed using a negative cough stress test (bladder filling 300 ml)
Subjective cure was defined as responding “never” to the question “Does urine leak when you are physically active, exert yourself, cough, or sneeze?”
Questionnaires were used to assess QofL, sexual health, and subjective success
King’s Health Questionnaire (KHQ)
Incontinence Outcome Questionnaire (IOQ)
Female Sexual Function Index (FSFI)
Patient Global Impression of Improvement questionnaire (PGI-I)
Minimum inclusion criteria of 12 months
Out of 52 women, 33 patients remained in the study population
29 women had tension-free vaginal tape (TVT), and 4 had the transobturator sling (TVT-O)
At a median follow-up of 11 years:
Subjective cure was 67% (22/33)
Objective cure was 65% (16/23)
Subjective success according to PGI-I was 78% (18/23)
Overall, QoL and sexual health were not significantly different between post-Burch vs. post-tape patients
No erosions of suture or tape material into the bladder, urethra, or vagina were seen
Some women had a third operation or required tape division and remained continent at follow-up
Midurethral tapes are an option for women with recurrent SUI after previous colposuspension or midurethral tape
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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