title: Surgical outcome of a repeat midurethral sling procedure after failure of a first procedure.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
authors.forename: Tae Heon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
authors.forename: Hyun Wook
authors.initials: HW
authors.lastname: You
authors.affiliation: Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Dong-Soo
authors.initials: DS
authors.lastname: Ryu
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 135-710, Republic of Korea. ksleedr@skku.edu.|Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea. ksleedr@skku.edu.
authors.forename: Kyu-Sung
authors.initials: KS
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000523:psychology / Q000601:surgery*
keywords: Prostheses and implants; Reoperation; Stress; Urinary incontinence