MP38-09 THE VALUE OF RETROPUBIC SLINGS FOLLOWING FAILED PRIOR ANTI-INCONTINENCE PROCEDURES

Abstract

INTRODUCTION AND OBJECTIVES: Mid-urethral slings (MUS) are considered first-line surgical treatment of stress urinary incontinence (SUI). However, there is a paucity of data regarding the use of retropubic slings for patients who failed a prior sling. This study compares the outcomes of retropubic mid-urethral slings (SPARC) to autologous pubovaginal rectus fascial slings (pvs) for sling refractory incontinence. METHODS: A retrospective review of 213 consecutive patients undergoing placement of SPARC (n1⁄4152) or pvs (n1⁄461) by two fellowship trained urologists for prior failed sling surgery was conducted over an eight-year time span. Mean follow-up was 29 months (range 3 to 93). Preand post-operative pad use was recorded for all patients in addition to completion of four validated questionnaires preand postoperatively: Stress-related leak, Emptying ability, Anatomy, Protection, Inhibition, Quality of life, Mobility and Mental status Incontinence Classification System (SEAPI-QMM), Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6) and Visual Analog Score (VAS). RESULTS: The overall subjective cure rate was 61.1%. 27 total patients (12.7%) required additional anti-incontinence procedures and the incidence of de novo urgency was 9.9% (21 patients). Short-term (<30days) urinary retention was the most common complication recorded (4.04% of all patients). The number of pads used per day reduced from a mean of 3.26 to a mean of 0.77 (p<0.0001) postoperatively. A statistically significant improvement between preand post-operative SEAPI total, IIQ-7, UDI-6 and VAS was demonstrated (p<0.0001). Sub-analysis comparing the SPARC to the rectus pvs used for secondary repair demonstrated no significant differences in subjective cure rates, post-operative pad use, SEAPI total, IIQ-7, UDI-6 or VAS between groups (Table 1). CONCLUSIONS: The widespread use of surgical slings for SUI has led to an increase in the absolute number of patients who fail their primary procedures. Secondary repair with a retropubic MUS is as durable and effective in improving QoL as the rectus pvs. This provides invaluable information for patient education and surgical planning for refractory stress incontinence.