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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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.
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