title: Repeat synthetic mid urethral sling procedure for women with recurrent stress urinary incontinence.
abstract: OBJECTIVE
  We reported and compared the outcomes of repeat mid urethral sling with primary mid urethral sling in women with stress urinary incontinence.
  
  
  METHODS
  A total of 1,225 consecutive women with urodynamic stress incontinence underwent a synthetic mid urethral sling procedure (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Of the patients 91% (1,112) were interviewed via telephone call with a structured questionnaire and were included in the analysis. Mean +/- SD followup was 50 +/- 24 months (range 12 to 114). A comparison between repeat (77, mean age 62 +/- 12 years) and primary (1,035, mean age 60 +/- 13 years) mid urethral sling groups was performed. Repeat sling was placed without removal of the previous sling.
  
  
  RESULTS
  The preoperative incidence of intrinsic sphincter deficiency was higher in patients who had a repeat mid urethral sling (31% vs 13%, p <0.001). The subjective stress incontinence cure rate was 86% and 62% in the primary and repeat group, respectively (p <0.001). The repeat retropubic approach was significantly more successful than the repeat transobturator approach (71% vs 48%, p = 0.04). The rates of sling related and general postoperative complications were similar between the primary and the repeat groups. However, de novo urgency (30% vs 14%, p <0.001) and de novo urge urinary incontinence (22% vs 5%, p <0.001) were more frequent in the repeat group compared with the primary group.
  
  
  CONCLUSIONS
  A repeat synthetic mid urethral sling procedure has a significantly lower cure rate than a primary mid urethral sling procedure. The repeat retropubic approach has a higher success rate than the repeat transobturator approach. The incidence of de novo urgency and urge incontinence are significantly higher in repeat procedures.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia. stavkobi@yahoo.com.au
authors.forename: Kobi
authors.initials: K
authors.lastname: Stav
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
authors.forename: Anna
authors.initials: A
authors.lastname: Rosamilia
authors.forename: Lore
authors.initials: L
authors.lastname: Schierlitz
authors.forename: Yik N
authors.initials: YN
authors.lastname: Lim
authors.forename: Fay
authors.initials: F
authors.lastname: Chao
authors.forename: Alison
authors.initials: A
authors.lastname: De Souza
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thomas
authors.forename: Christine
authors.initials: C
authors.lastname: Murray
authors.forename: Christine
authors.initials: C
authors.lastname: Conway
authors.forename: Joseph
authors.initials: J
authors.lastname: Lee
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*