Sling location in women with recurrent stress urinary incontinence following midurethral sling

Persistent or recurrent stress urinary incontinence (SUI) after a midurethral sling (MUS) may result from incorrect location of the sling relative to the midurethra. This study's objective was to evaluate the incidence of bladder neck (BN) or more proximal MUS in women undergoing reoperation for SUI after synthetic MUS.

A retrospective review was performed of patients referred and treated for isolated recurrent SUI after synthetic MUS (transobturator or retropubic approach). Patients undergoing sling excision for other indications (eg, outlet obstruction, urinary tract erosion) were excluded. Preoperative video urodynamic (VUDS) parameters were examined. Operative reports at re-exploration provided the anatomic location of the sling.

Fifteen women with SUI after MUS underwent VUDS and subsequent reoperation. The MUS was found proximal to or at the BN in 8 (53%) women and suburethral in 7 (47%). Women with BN or proximal sling location were equally likely to have an open (4/8 patients) or closed BN (4/8 patients) at rest on filling cystography. VUDS parameters, including the radiographic finding of an open BN preoperatively, were not predictive of BN or more proximal sling location intraoperatively. MUSs found at the BN or proximal were more likely to be retropubic slings (7/8 patients). Rates of concomitant anterior prolapse repair did not differ according to sling location.

Recurrent SUI as a result of proximal MUS location cannot be predicted on preoperative VUDS parameters. Surgical exploration is the primary method for identifying this phenomenon as the etiology of failure in these patients.