Second-Line Surgical Management After Midurethral Sling Failure.

Area of Science:

• Urology
• Gynecology
• Female Pelvic Medicine

Background:

• Midurethral sling (MUS) surgery is a standard treatment for stress urinary incontinence (SUI).
• MUS procedures have reported failure rates ranging from 5% to 20%.
• Sling failure encompasses persistent SUI, recurrence, and complications like mesh exposure or voiding difficulties.

Purpose of the Study:

• To review and outline second-line management options for failed midurethral sling procedures for SUI.
• To provide guidance on selecting appropriate surgical interventions based on patient-specific factors and reasons for initial failure.

Main Methods:

• Literature review of existing studies on second-line surgical treatments for SUI after MUS failure.
• Analysis of available options including transurethral bulking agents, tape shortening, repeat MUS, pubovaginal sling (PVS), and Burch colposuspension.
• Evaluation of treatment efficacy, durability, and suitability for different patient profiles and complication types.

Main Results:

• Repeat MUS is the most frequent second-line surgical approach.
• Pubovaginal sling (PVS) and retropubic (RP) MUS show higher success rates for intrinsic sphincter deficiency.
• Mesh-free procedures like PVS or colposuspension are recommended for mesh-related complications.
• Readjustable slings may be preferable for patients with detrusor underactivity to mitigate voiding dysfunction risks.

Conclusions:

• Second-line management for SUI after MUS failure requires individualized treatment selection.
• Specific patient conditions, such as intrinsic sphincter deficiency or detrusor underactivity, dictate the optimal surgical choice.
• Consideration of mesh-related complications influences the decision towards non-mesh procedures for revision surgeries.