Management of recurrent stress urinary incontinence after burch and sling procedures Journal Article

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Authors: Zimmern, P. E.; Gormley, E. A.; Stoddard, A. M.; Lukacz, E. S.; Sirls, L; Brubaker, L; Norton, P.; Oliphant, S. S.; Wilson, T.
Article Title: Management of recurrent stress urinary incontinence after burch and sling procedures
Abstract: AIMS: To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures. METHODS: We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated. RESULTS: Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%), and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (P 0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (P 0.0001). CONCLUSION: In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment. Neurourol. Urodynam. (c) 2015 Wiley Periodicals, Inc.
Journal Title: Neurourology and urodynamics
ISSN: 1520-6777; 0733-2467
Publisher: Wiley Periodicals, Inc  
Date Published: 2015
Language: ENG
DOI/URL:

10.1002/nau.22714
Notes: LR: 20150120; CI: (c) 2015; JID: 8303326; OTO: NOTNLM; 2014/07/24 [received]; 2014/10/29 [accepted]; aheadofprint