A repeat mid-urethral sling as valuable treatment for persistent or recurrent stress urinary incontinence

The value of a repeat mid-urethral sling (MUS) after a failed primary sling is not generally accepted. We hypothesize that repeat MUS can be performed with favorable results and acceptable complication rates.

We reviewed the medical records of 80 women (mean age 62 ± 12.3 years) who underwent repeat MUS surgery from January 2000 to January 2009 at a single tertiary academic centre. Mean follow-up was 44.8 months (range 3-104). Three of these 80 patients were lost to follow-up. Twenty-six (33%) transobturator (TOT), 25 (31%) retropubic (TVT) and 16 (20%) minislings were placed as secondary slings. Thirteen slings (15%) were biological (Pelvicol™). In 4 patients (5%) a release of the primary sling was performed, and in 6 (7.5 %) the extruded sling fragment was totally excised prior to secondary sling placement.

The overall subjective cure rate was 61.0%. Of the study group 74.0% reported subjective improvement. The amounts of pads reduced from a mean of 3.8 pads a day to a mean of 0.75 pads a day postoperatively. The objective cure rate was 63.5%. The incidence of de novo urgency was 8.2% (4 patients). When comparing different secondary sling types no difference was found in the overall continence rate, except for the biological sling. More than half (7 out of 13) of the patients from whom the secondary sling was a biological sling, were not satisfied (p=0.01). The subjective improvement rates in patients with recurrent or persistent stress urinary incontinence (SUI) were 68.2% and 75.0% respectively. This difference is not statistically significant (p=0.94). Excision versus release of the MUS showed a slightly higher satisfaction rate after excision, 84.6% and 74.0 % respectively (p=0.63).

Cure rates and improvement rates of a repeat MUS are favorable and complication rates are acceptable. It should be offered to patients with persistent or recurrent SUI after a failed primary sling, even after previous release or excision.