Second sling improves QoL when first surgery fails

Women who have unsuccessful midurethral sling surgery for stress urinary incontinence and then undergo a second midurethral sling surgery see more quality of life symptom improvement than women who undergo only a first procedure, a new study from the University of Alabama at Birmingham found.

The goal of the study, published in Obstetrics and Gynecology (2013; 121:273–8), was to assess and compare continence outcomes of women undergoing a first and repeat midurethral sling procedure. It was also designed to compare lower urinary tract symptoms, patient satisfaction, and patient impression of improvement of their stress incontinence. Looking at previous small studies, the UAB researchers hypothesized that women undergoing a repeat procedure would have outcomes similar to those who experienced a successful procedure the first time.

The team looked at 1,316 patients who underwent midurethral sling procedures from April 1, 2006 to Dec. 31, 2009 at UAB. Of those patients, 135 (10.2%) had undergone prior procedures. Women in the study group were defined as those who had documentation of a prior procedure; women in the control group were defined as those who had no history of having had a prior procedure. Minimum follow-up was 12 months. All eligible patients were mailed six different questionnaires assessing satisfaction and symptoms after surgery, which included questions on measures of satisfaction and patient impression of improvement.

Despite a higher success rate in the group undergoing their first midurethral sling surgery, both groups reported similar improvement in stress incontinence, urgency urinary incontinence, and overall distress from urinary symptoms. However, the patients who had repeat operations had significantly better symptom-specific quality of life scores.

"This implies that any degree of improvement may be more effective if symptoms are worse at baseline, even if success as defined by the lack of moderately bothersome urinary incontinence is not met," said senior author Holly E. Richter, MD, PhD. "Also, the prior failed midurethral sling procedure may heighten patients’ perceived appreciation of any symptom improvement after a repeat procedure. This may also help explain why participants reported similar satisfaction rates among groups.

"Our hope is that this information will be used to educate women considering repeat procedures that while their results may not be the same as in women undergoing a successful primary surgery, they will have significant improvement of symptoms and impact on quality of life."

Dr. Richter has been a consultant to Astellas, GlaxoSmithKline, Uromedica, IDEO, Pfizer, and Xanodyne. She has received research grants from Pelvalon, Astellas, Warner Chilcott, University of California/Pfizer, and Pfizer.