Urodynamics for incontinence after midurethral sling removal

Area of Science:

• Urology
• Female Pelvic Medicine and Reconstructive Surgery

Background:

• Persistent or recurrent urinary incontinence (UI) after mid-urethral sling removal (MUSR) presents a management challenge.
• Current guidelines for urodynamics (UDS) in this context have a low level of evidence.

Purpose of the Study:

• To review the role of urodynamics (UDS) in guiding the management of women experiencing persistent or recurrent urinary incontinence (UI) after mid-urethral sling removal (MUSR).

Main Methods:

• A longitudinal database was reviewed for women who underwent UDS after MUSR for persistent/recurrent UI.
• Exclusion criteria included neurogenic bladder, obstructive symptoms without UI, fistula, advanced prolapse, or concomitant autologous sling surgery.
• Data collected included time between MUSR and UDS, UDS findings, and subsequent UI management.

Main Results:

• UDS was performed on 71 women after MUSR for UI between 2006-2013; 54 were included in the final analysis.
• UDS identified incontinence in 78% of patients, including stress urinary incontinence (SUI), detrusor overactivity incontinence (DOI), and mixed urinary incontinence (MUI).
• Voiding patterns varied, and UDS data informed counseling and treatment planning, with urethral bulking agents chosen in 43% of cases.

Conclusions:

• This study reinforces the utility of urodynamics (UDS) in the management of urinary incontinence (UI) following mid-urethral sling removal (MUSR).
• UDS findings are crucial for guiding subsequent therapeutic interventions and patient counseling in this specific patient population.