BACKGROUND: Despite a wide spectrum of interventions, surgical treatments of recurrent stress urinary incontinence (SUI) are associated with high failure rates.
OBJECTIVES: To systematically review current evidence on the effectiveness of surgical interventions for recurrent SUI.
DATA SOURCES: An electronic database search was undertaken (1980-2014). Keywords were: 'stress urinary incontinence', 'failure', 'recurrence', 'treatment'. References of identified studies and abstracts from conferences were considered.
STUDY SELECTION: We restricted the search to female patients and currently used surgical procedures, including studies with ≥5 cases. After the initial yield, studies were selected following title screening, abstract and full text scrutiny.
RESULTS: The pooled objective cure rates of colposuspension for recurrent SUI are 76% (95%CI: ±5.04), whereas rates for midurethral sling procedures are 68.5% (95%CI: ±3.11). Repeat midurethral sling procedures have pooled success rates of 66.2% (95%CI: ±4) but those of the transobturator approach appear lower than retropubic procedures. Pubovaginal slings for recurrent SUI, have pooled success of 79.3% (95%CI: ±6.54). Success rates for adjustable continence therapy and adjustable slings for recurrent SUI are 53.8% (95%CI: ±5.28), whereas for midurethral sling procedures fixation the pooled success is 61% (95%CI: ±10.56). Urethral bulking injections have success rates of 38% (95%CI:±10.7). Laparoscopic two-team sling procedures, salvage spiral slings and artificial urinary sphincter have shown promising results, but there is limited data on recurrent cases.
CONCLUSION: There is a wide spectrum of surgical interventions reported for secondary or tertiary treatment of SUI. A common characteristic for all recurrent procedures is a lower success rate compared to those reported following primary procedures.
Written by:
Nikolopoulos KI, Betschart C, Doumouchtsis SK. Are you the author?
Urogynaecology Unit, Department of Obstetrics and Gynaecology, St. George's Healthcare NHS Trust, St George's University of London, London, UK.
Reference: Acta Obstet Gynecol Scand. 2015 Mar 4. Epub ahead of print.
doi: 10.1111/aogs.12625
PubMed Abstract
PMID: 25737292