Low Rate of Repeat Surgery Despite Recurrent SUI

Some 83% of women who experienced SUI after sling release reported feeling significantly bothered by their symptoms.
Some 83% of women who experienced SUI after sling release reported feeling significantly bothered by their symptoms.

Only 14% of women at a medical center chose to have repeat surgery for stress urinary incontinence (SUI) following release of a synthetic sling for iatrogenic obstruction, a new study finds. Yet, 49% and 77% of these women experienced recurrent and persistent SUI, respectively.

Nitya Abraham, MD, of Montefiore Medical Center in the Bronx, New York, and colleagues examined repeat surgery and recurrent SUI rates for 107 women who had a synthetic mid-urethral sling release at their center from 2005 to 2013. The release procedure involved either simple incision or full or partial excision of the sub-urethral portion of the synthetic sling causing obstruction.

“The rate of recurrent SUI after sling release surgery is high while the rate of repeat surgery for SUI is low,” Dr Abraham explained to Renal & Urology News. “We suspect that women were frustrated with the complications of their surgery, and despite having bothersome SUI, chose not to undergo a repeat intervention.”

The likelihood of repeat surgery decreased as more time elapsed between sling placement and release. According to a multivariable analysis, the women were 88% less likely to undergo repeat surgery when sling release was performed more than 24 months after placement compared with release within 3 months. About 43% of initial surgeries were transobturator slings.

“We do not recommend postponing sling release surgery if obstruction is suspected,” Dr Abraham stated. “Our personal practice is to detension a sling with two weeks if there are signs of obstruction.”

Previous studies of all types of sling revision and removal procedures have found similarly low rates of repeat SUI surgery ranging from 7% to 14%. Since a majority of patients now undergo placement of a synthetic sling, these results are useful for patient counseling, the investigators wrote in Neurology and Urodynamics. Future studies should explore the reasons.

Source

  1. Abraham N, Makovey I, King A, Goldman HB, and Vasavada S. The Effect of Time to Release of an Obstructing Synthetic Mid-Urethral Sling on Repeat Surgery for Stress Urinary Incontinence. Neurology and Urodynamics. doi: 10.1002/nau.22927.
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