PURPOSE: There is no consensus on the management of persistent or recurrent stress incontinence (SUI) after a failed synthetic midurethral sling.
After a mesh complication or sling failure many women and surgeons prefer to avoid a repeat mesh procedure and chose an autologous pubovaginal slings (APVS), however little empirical work has been performed to assess the efficacy.
MATERIALS AND METHODS: We performed a retrospective review of 66 women who underwent APVS with rectus fascia following one or more failed synthetic midurethral sling from 2007-12.
RESULTS: Mesh removal was performed prior to APVS in 21 patients (31.8%) while six (9.1%) had mesh removed simultaneously with APVS. Indication for the APVS was pure SUI in 16 patients (24.2%), mixed incontinence in 50 (75.8%), eight of whom were deemed "complex" with a prior urethral diverticulum or urethrovaginal fistula/urethral mesh erosion. At a mean of 14.5 months following APVS 46 (69.7%) of patients reported cure of SUI. Of these, 25 (37.9%) had complete cure with no stress or urgency incontinence, 17 had cure of their SUI but persistent urgency incontinence, and 4 had cure of SUI but developed do novo urgency incontinence. Requiring a mesh excision did not predict worse outcomes compared to those patients where mesh was not removed (p=0.13). Patients with pure SUI were significantly more likely to be cured of all incontinence (62.5%) than those women with pre-operative mixed incontinence (30.0%) (p=0.006).
CONCLUSION: Even after a failed synthetic midurethral sling APVS is very effective and cured SUI in 69.7% of cases.
Written by:
Milose JC, Sharp KM, He C, Stoffel J, Clemens JQ, Cameron AP. Are you the author?
University of Michigan Department of Urology; University of Michigan Department of Obstetrics and Gynecology.
Reference: J Urol. 2014 Sep 19. pii: S0022-5347(14)04434-6.
doi: 10.1016/j.juro.2014.09.038
PubMed Abstract
PMID: 25245488