title: Management of recurrent stress urinary incontinence after burch and sling procedures.
abstract: OBJECTIVE
  To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures.
  
  
  METHODS
  We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated.
  
  
  RESULTS
  Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%), and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (P < 0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (P < 0.0001).
  
  
  CONCLUSIONS
  In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment.
authors.affiliation: UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: E Ann
authors.initials: EA
authors.lastname: Gormley
authors.affiliation: New England Research Institute, Watertown, Massachusetts.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stoddard
authors.affiliation: University of California, San Diego, California.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Lukacz
authors.affiliation: Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Larry
authors.initials: L
authors.lastname: Sirls
authors.affiliation: Loyola University, Maywood, Illinois.
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.affiliation: University of Utah, Salt Lake City, Utha.
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.affiliation: University of Arkansas, Little Rock, Arkansas.
authors.forename: Sallie S
authors.initials: SS
authors.lastname: Oliphant
authors.affiliation: University of Alabama at Brimingham, Birmingham, Alabama.
authors.forename: Tracey
authors.initials: T
authors.lastname: Wilson
mesh_terms: D000328:Adult; D064592:Autografts; D018572:Disease-Free Survival; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D053825:Suburethral Slings; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods
keywords: female; recurrent stress urinary incontinence; surgical treatment