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Management of recurrent stress urinary incontinence after failed midurethral sling: a survey of members of the International Urogynecological Association (IUGA)

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Abstract

Introduction and hypothesis

Synthetic midurethral slings (MUS) have gained popularity in the management of stress urinary incontinence (SUI), due to their efficacy and minimally invasive nature. As there are no robust data to guide management of persistent or recurrent SUI after failed MUS, the aim of this study was to evaluate the management of these cases among IUGA members.

Methods

A pretested, web-based survey designed to explore assessment, surgical management and views about future research was sent to IUGA members.

Results

A total of 385 participants opened the survey and 331 eligible responses were obtained. Conventional laboratory urodynamics were the most commonly used investigation (72.6 %). The type of previous surgery, urodynamic findings and surgeon’s preference/experience were considered to be the most important factors in choosing the type of surgical management. Retropubic sling (RPS) was the preferred surgical option in most of the clinical scenarios with urethral bulking agents (UBA) being more popular in the absence of urethral hypermobility after a failed RPS. While the vast majority of the respondents (93.0 %) recognized the urgent need for good quality research, they were less willing to participate in randomized controlled trials (RCT) comparing redo MUS with autologous fascial sling or colposuspension.

Conclusions

Members of IUGA prefer RPS in most patients and UBA in patients with absent urethral hypermobility and intrinsic sphincter deficiency. There is a recognized need for good quality research, but IUGA members are reluctant to participate in RCTs comparing minimally invasive to conventional surgical techniques.

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References

  1. Hunskaar S, Lose G, Sykes D, Voss S (2004) The prevalence of urinary incontinence in women in four European countries. BJU Int 93:324–330

    Article  CAS  PubMed  Google Scholar 

  2. Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS et al (2009) The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int 104:352–360

    Article  PubMed  Google Scholar 

  3. Bent AE (2008) Stress urinary incontinence. In: Rock JA, Jones HW (eds) Te Linde’s operative gynecology, 10th edn. Lippincott Williams & Wilkins, Philadelphia, pp 942–959

    Google Scholar 

  4. Withington J, Hirji S, Sahai A (2014) The changing face of urinary continence surgery in England: a perspective from the Hospital Episode Statistics database. BJU Int 114:268–277

    Article  PubMed  Google Scholar 

  5. Lee J, Dwyer PL (2010) Age-related trends in female stress urinary incontinence surgery in Australia – Medicare data for 1994–2009. Aust N Z J Obstet Gynaecol 50:543–549

    Article  PubMed  Google Scholar 

  6. Ulmsten U, Falconer C, Johnson P, Jomaa M, Lannér L, Nilsson CG et al (1998) A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 9:210–213

    Article  CAS  PubMed  Google Scholar 

  7. Delorme E, Droupy S, de Tayrac R, Delmas V (2004) Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 45:203–207

    Article  PubMed  Google Scholar 

  8. Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT et al (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362:2066–2076

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Lovatsis D, Easton W, Wilkie D, Society of Obstetricians and Gynaecologists of Canada Urogynaecology Committee (2010) Guidelines for the evaluation and treatment of recurrent urinary incontinence following pelvic floor surgery. J Obstet Gynaecol Can 32:893–904

    PubMed  Google Scholar 

  10. Giarenis I, Mastoroudes H, Cardozo L, Robinson D (2012) What do we do when a midurethral tape fails? Rediscovery of open colposuspension as a salvage continence operation. Int Urogynecol J 23:1117–1122

    Article  PubMed  Google Scholar 

  11. Bakali E, Buckley BS, Hilton P, Tincello DG (2013) Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women. Cochrane Database Syst Rev 2:CD009407

    PubMed  Google Scholar 

  12. Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Chao F et al (2010) Repeat synthetic mid urethral sling procedure for women with recurrent stress urinary incontinence. J Urol 183:241–246

    Article  PubMed  Google Scholar 

  13. National Institute for Health and Care Excellence (2013) Urinary incontinence in women (CG171). National Institute for Health and Care Excellence, London

    Google Scholar 

  14. Tubaro A, Vodusek DB, Amarenko G, Doumouchtsis SK, DeLancey J, Fernando R et al (2013) Imaging, neurophysiological testing and other tests. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence, 5th edn. Health Publication, Paris, pp 507–622

    Google Scholar 

  15. Liapis A, Bakas P, Creatsas G (2009) Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Eur Urol 55:1450–1458

    Article  PubMed  Google Scholar 

  16. Kociszewski J, Rautenberg O, Kolben S, Eberhard J, Hilgers R, Viereck V (2010) Tape functionality: position, change in shape, and outcome after TVT procedure – mid-term results. Int Urogynecol J 21:795–800

    Article  PubMed Central  PubMed  Google Scholar 

  17. Giarenis I, Cardozo L (2013) What is the value of urodynamic studies before stress incontinence surgery? BJOG 120:130–132

    Article  CAS  PubMed  Google Scholar 

  18. Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A et al (2008) Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet Gynecol 112:1253–1261

    Article  PubMed  Google Scholar 

  19. Mostafa A, Lim CP, Hopper L, Madhuvrata P, Abdel-Fattah M (2014) Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications. Eur Urol 65:402–427

    Article  PubMed  Google Scholar 

  20. Lee KS, Doo CK, Han DH, Jung BJ, Han JY, Choo MS (2007) Outcomes following repeat mid urethral synthetic sling after failure of the initial sling procedure: rediscovery of the tension-free vaginal tape procedure. J Urol 178:1370–1374

    Article  PubMed  Google Scholar 

  21. Han JY, Moon KH, Park CM, Choo MS (2012) Management of recurrent stress urinary incontinence after failed midurethral sling: tape tightening or repeat sling? Int Urogynecol J 23:1279–1284

    Article  PubMed  Google Scholar 

  22. Gaddi A, Guaderrama N, Bassiouni N, Bebchuk J, Whitcomb EL (2014) Repeat midurethral sling compared with urethral bulking for recurrent stress urinary incontinence. Obstet Gynecol 123:1207–1212

    Article  PubMed  Google Scholar 

  23. Riad M, Familusi A, El Sayad M, Abdel-Fattah M (2011) Current practice in the UK for the assessment and management of recurrent stress urinary incontinence in women. Int Urogynecol J 22:S63–S65

    Google Scholar 

  24. Long CY, Hsu CS, Lo TS, Liu CM, Chen YH, Tsai EM (2008) Ultrasonographic assessment of tape location following tension-free vaginal tape and transobturator tape procedure. Acta Obstet Gynecol Scand 87:116–121

    Article  PubMed  Google Scholar 

  25. Milose JC, Sharp KM, He C, Stoffel J, Clemens JQ, Cameron AP (2015) Success of autologous pubovaginal sling following failed synthetic midurethral sling. J Urol 193:916–920

    Article  PubMed  Google Scholar 

  26. Jonsson Funk M, Levin PJ, Wu JM (2012) Trends in the surgical management of stress urinary incontinence. Obstet Gynecol 119:845–851

    Article  PubMed  Google Scholar 

  27. Hilton P, Bryant A, Howel D, McColl E, Buckley BS, Lucas M et al (2012) Assessing professional equipoise and views about a future clinical trial of invasive urodynamics prior to surgery for stress urinary incontinence in women: a survey within a mixed methods feasibility study. Neurourol Urodyn 31:1223–1230

    Article  PubMed Central  PubMed  Google Scholar 

  28. Khaja A, Freeman RM (2014) How often should shelf/Gellhorn pessaries be changed? A survey of IUGA urogynaecologists. Int Urogynecol J 25:941–946

    Article  CAS  PubMed  Google Scholar 

  29. Gonipath D, Smith AR, Holland C, Reid FM (2013) Why don’t women participate? A qualitative study of non-participation in a surgical randomised controlled trial. Int Urogynecol J 24:969–975

    Article  Google Scholar 

  30. Bakali E, Pitchforth E, Tincello DG, Kenyon S, Slack M, Toozs-Hobson P (2011) Clinicians’ views on the feasibility of surgical randomized trials in urogynecology: results of a questionnaire survey. Neurourol Urodyn 30:69–74

    Article  PubMed  Google Scholar 

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Acknowledgments

We acknowledge the contribution of those who responded to the questionnaire. The authors would like to thank Dr. Dorothy Kammerer-Doak and Dr. Peter Rosier for their contribution in the development of the questionnaire.

Conflicts of interest

I. Giarenis – Speaker honorarium: Astellas. Travel expenses: Astellas, Ethicon, Pfizer.

G. Thiagamoorthy – Travel expenses: Astellas, Ethicon.

M. Zacchè – Travel expenses: Astellas.

D. Robinson – Consultant: Allergan, Astellas, Ferring, Pfizer. Speaker honorarium: Allergan, Astellas, Ferring, Pfizer. Trial participation: Allergan, Astellas, Pfizer.

L. Cardozo – Consultant: Allergan, AMS, Astellas. Speaker honorarium: Astellas, Allergan. Trial participation: Pfizer.

Authors’ contributions to preparation of the manuscript

I. Giarenis: Project development, data collection, data analysis, manuscript writing

G. Thiagamoorthy: Data collection, data analysis, manuscript writing

M. Zacchè: Data collection, data analysis, manuscript writing

D. Robinson: Project development, manuscript writing

L. Cardozo: Project development, manuscript writing

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Authors and Affiliations

  1. Department of Urogynaecology, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK

    Ilias Giarenis, Ganesh Thiagamoorthy, Martino Zacchè, Dudley Robinson & Linda Cardozo

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  1. Ilias Giarenis
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  2. Ganesh Thiagamoorthy
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  3. Martino Zacchè
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  4. Dudley Robinson
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  5. Linda Cardozo
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Correspondence to Ilias Giarenis.

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Giarenis, I., Thiagamoorthy, G., Zacchè, M. et al. Management of recurrent stress urinary incontinence after failed midurethral sling: a survey of members of the International Urogynecological Association (IUGA). Int Urogynecol J 26, 1285–1291 (2015). https://doi.org/10.1007/s00192-015-2696-7

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  • DOI: https://doi.org/10.1007/s00192-015-2696-7

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