Tape tightening for persistent or recurrent stress urinary incontinence following mid-urethral sling surgery

Mid-urethral sling (MUS) is considered the Gold Standard surgical treatment for stress urinary incontinence (SUI). However, failure rates following this procedure are up to 20%. Optimal treatment for persistent or recurrent SUI has not been standardized. MUS tape readjustment or tightening has been previously proposed as a management option. The aim of the study was to assess the feasibility of MUS tape tightening for recurrent or persistent stress urinary incontinences after a MUS.

This was a retrospective cohort study of patients who complained of recurrent or persistent SUI after an MUS and were treated with tape tightening in two urogynecological centers, between September 2013 and April 2022. Patients were only considered for this procedure following discussion in a multidisciplinary urogynecology meeting. The outcome of interest for this study was absence of bothersome SUI at follow-up.

A total of 27 patients were included in our analysis. The median duration between their index MUS and tape tightening was 9 months. Three patients were lost to follow-up. Of the remaining 24, 15 (62.5%) reported resolution or significant improvement of their SUI symptoms, while 5 (20.8%), 3 (12.5%) and 1 patient (4.2%%) reported little improvement, no change and worsening in symptoms respectively.

Mid-urethral sling failure is a challenge for urogynecologists with no standardized management strategy. MUS tape tightening is a feasible procedure that seems to offer a safe, minimal invasive and effective management option. Further properly powered prospective studies are needed to confirm these observations.

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