title: An adjustable sling in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape.
abstract: OBJECTIVE
  The aim of this prospective study was to evaluate the feasibility and outcome of an adjustable sling system AMI in patients with recurrent urinary stress incontinence after failed suburethral sling insertion.
  
  
  METHODS
  Twenty-five patients with recurrent urinary stress incontinence treated with an adjustable sling system AMI were analyzed for feasibility and outcome. Patients' incontinence bother was quantified using the Visual Analogue Scale (VAS) from 0 to 10. Multichannel urodynamics and pad tests were pre- and postoperatively performed. Time of adjustment, time of the surgical intervention, and clinical outcome were also recorded.
  
  
  RESULTS
  Twenty-five patients were treated with the adjustable sling system AMI. Median time of adjustment was 3 days (range 1-8) and a median follow up time of 12 months. Twenty-one out of 25 patients were continent, four patients suffered from persisting incontinence. One patient was put on clean intermittent self-catheterization (CISC). Detrusor pressure at maximum flow rate (pdet/Qmax) increased significantly as did the maximum urethral closure pressure (MUCP). Patient satisfaction improved significantly.
  
  
  CONCLUSIONS
  Adjustable slings in women with stress urinary incontinence might be indicated in difficult situations after surgical failure. As we present a selective group of patients these findings may not apply to other patients with recurrent stress incontinence.
authors.affiliation: Department of Gynaecology, Urogynaecology Division, University Hospital of Bern and University of Bern, Switzerland.
authors.forename: Corina
authors.initials: C
authors.lastname: Schmid
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bloch
authors.forename: Esther
authors.initials: E
authors.lastname: Amann
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mueller
authors.forename: Annette
authors.initials: A
authors.lastname: Kuhn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012720:Severity of Illness Index; D053825:Suburethral Slings; D017211:Treatment Failure; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology* / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods