title: Repeat midurethral sling compared with urethral bulking for recurrent stress urinary incontinence.
abstract: OBJECTIVE
  To compare the effectiveness and safety of repeat midurethral sling with urethral bulking after failed midurethral sling.
  
  
  METHODS
  This is a retrospective cohort study of patients within Kaiser Permanente Southern California Medical Group who underwent a midurethral sling for stress urinary incontinence (SUI) from 2008 to 2011 and subsequently had either a midurethral sling or urethral bulking for recurrent SUI. Current Procedural Terminology codes were used to identify patients and electronic medical records were queried for individual patient information. Our primary outcome was either subjective failure defined by SUI or objective failure defined as a positive cough stress test, urodynamic stress incontinence, or retreatment for SUI. Secondary outcomes included perioperative complications and adverse events.
  
  
  RESULTS
  Of 6,914 midurethral slings performed, 165 patients underwent a repeat procedure for recurrent SUI, including 98 midurethral slings and 67 urethral bulking. Of the 165 patients who underwent repeat procedures, there were 11 failures (11.2%) in the midurethral sling group and 26 failures (38.8%) in the urethral bulking group (P=.004). There were no differences in perioperative complications or adverse events between the groups. In multivariable logistic regression, risk of failure was significantly higher in those undergoing urethral bulking compared with those undergoing midurethral sling (odds ratio 3.49, 95% confidence interval 1.34-9.09, P=.01).
  
  
  CONCLUSIONS
  In a managed care population, urethral bulking was associated with higher risk of failure than repeat midurethral sling after primary midurethral sling failure with no differences in perioperative complications or adverse events.
  
  
  METHODS
  II.
authors.affiliation: Departments of Obstetrics and Gynecology and Research and Evaluation, Southern California Permanente Medical Group, Irvine Medical Center, Irvine, California.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gaddi
authors.forename: Noelani
authors.initials: N
authors.lastname: Guaderrama
authors.forename: Nora
authors.initials: N
authors.lastname: Bassiouni
authors.forename: Judith
authors.initials: J
authors.lastname: Bebchuk
authors.forename: Emily L
authors.initials: EL
authors.lastname: Whitcomb
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D019919:Prosthesis Implantation / Q000706:statistics & numerical data*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*