1181 TREATMENT OF RECURRENT STRESS URINARY INCONTINENCE AFTER MID URETHRAL SYNTHETIC SLING WITH A PUBOVAGINAL SLING, A SINGLE INSTITUTION EXPERIENCE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20121181 TREATMENT OF RECURRENT STRESS URINARY INCONTINENCE AFTER MID URETHRAL SYNTHETIC SLING WITH A PUBOVAGINAL SLING, A SINGLE INSTITUTION EXPERIENCE Jennifer Rothschild, Ekene Enemchukwu, Lorraine Alexis, W. Stuart Reynolds, Harriette Scarpero, Melissa Kaufman, and Roger Dmochowski Jennifer RothschildJennifer Rothschild Nashville, TN More articles by this author , Ekene EnemchukwuEkene Enemchukwu Nashville, TN More articles by this author , Lorraine AlexisLorraine Alexis Nashville, TN More articles by this author , W. Stuart ReynoldsW. Stuart Reynolds Nashville, TN More articles by this author , Harriette ScarperoHarriette Scarpero Nashville, TN More articles by this author , Melissa KaufmanMelissa Kaufman Nashville, TN More articles by this author , and Roger DmochowskiRoger Dmochowski Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1426AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although mid urethral synthetic slings (MUSS) have been favorably used in the past for the surgical treatment of SUI, they are currently under scrutiny due to synthetic mesh complications. Most published data on MUSS report a cure rate of 77% to 88% with a standard failure rate quoted at 10−20%. Therefore, a significant amount of women undergoing MUSS will not have successful outcomes and will have recurrent SUI. Although there are many treatment options for recurrent SUI, there are no specific studies on the role of autologous pubovaginal sling (PVS) in women with a prior failed MUSS. We present our experience of the efficacy and complications of PVS in patients with recurrent stress urinary incontinence after failed mid urethral synthetic sling. METHODS Retrospective review of 114 patients with stress urinary incontinence following mid urethral sling surgery who underwent subsequent pubovaginal sling placement from 2006 through 2010 were evaluated for demographics, history, symptoms, subjective outcomes, and complications. RESULTS Of the 114 patients reviewed, 22 patients had recurrent SUI following MUSS surgery. Although all women reported SUI, 14 (64%) had additional symptoms: frequency (14%); mixed incontinence (5%); frequency, urge and mixed incontinence (45%);and dysuria (24%). In addition to prior MUSS, 8 patients had between 2−4 additional surgeries: prior MUSS (5), urethral bulking (5), and prior PVS (3). At the time of the PVS surgery, 13 (59%) underwent concurrent urethrolysis. All 22 patients received autologous abdominal rectus fascia. At a mean follow−up of 10 months, 15 (68%) of the PVS procedures were considered successful with no SUI and no additional SUI surgery. Complications included 7 (32%) women who developed urinary retention and they were treated with an indwelling catheter (1), intermittent catheterization (5) or suprapubic tube (1). Of the 22 patients, 11 (50%) reported no urinary urgency while 9 reported continued or worsening symptoms of urgency. Prior surgeries was not associated with successful outcomes, Fisher's exact test, p = 0.268. CONCLUSIONS Pubovaginal sling is a reasonable option to offer patients who have recurrent SUI after failed mid urethral synthetic sling surgery. In our series, 68% of women were successfully treated with PVS, although post−op urgency and retention rates remained high. Additional analyses are needed to identify other predictive variables. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e478-e479 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Rothschild Nashville, TN More articles by this author Ekene Enemchukwu Nashville, TN More articles by this author Lorraine Alexis Nashville, TN More articles by this author W. Stuart Reynolds Nashville, TN More articles by this author Harriette Scarpero Nashville, TN More articles by this author Melissa Kaufman Nashville, TN More articles by this author Roger Dmochowski Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...