Surgical outcome of a repeat midurethral sling procedure after failure of a first procedure

Introduction and hypothesis: Although there is no consensus on the management of persistent or recurrent stress urinary incontinence (SUI) after placement of a midurethral synthetic sling (MUS), a repeat MUS procedure is commonly performed with favorable results. The aim of this study was to evaluate the efficacy of a repeat MUS procedure compared to the primary procedure in women with SUI, and to investigate factors associated with the failure of the repeat procedure. Methods: We retrospectively analyzed data from 53 women who underwent a repeat MUS procedure and 102 women who underwent a primary MUS procedure at a single center. Success was defined as no urine leakage during physical activity based on the Sandvik questionnaire. Outcomes were assessed using the Sandvik Severity Index and Incontinence-Quality of Life (I-QOL) questionnaire. Multivariate logistic regression analysis was used to determine the factors predicting failure of the repeat procedure. Results: The success rate was 76.5 % for the primary MUS procedure (78/102 patients) and 69.8 % for the repeat MUS procedure (37/53 patients; p = 0.369). The mean follow-up duration was significantly longer for the primary procedure (83.8 months vs. 54.6 months, p < 0.001). SUI and all domain scores of the I-QOL were significantly better following the repeat MUS procedure than following the primary procedure. In the multivariate analysis, SUI grade 3 was the only independent factor predicting failure of the repeat qq (odds ratio 7.610, p = 0.023). Conclusions: A repeat MUS procedure after a failed primary MUS procedure was shown to be effective. However, a repeat procedure may be unsuccessful in patients with grade 3 SUI.