title: [Management of recurrent stress urinary incontinence after anti-incontinence surgery].
abstract: OBJECTIVE
  The review article describes the possibilities of procedures for failed anti-incontinence surgery - sling procedure or "bulking agent"?
  
  
  METHODS
  Review article.
  
  
  METHODS
  Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.
  
  
  METHODS
  The correct choice of procedure type to treat persistent SUI (Stress Urinary Incontinence) which persists or soon reoccurs after anti-incontinence surgery is often problematic. The procedures that treat SUI decrease excessive mobility of the urethra by partially compressing it. If the excessive mobility of the urethra and BN (bladder neck) persist and MUCP (Maximal Urethral Closure Pressure) is within normal range, then we choose a new sling operation to treat the persistent SUI. What type of sling procedure is preferable in this situatitons: transobturator, retropubic or possibly SISs (Single Incision Slings)? SISs are not adequately fixed to the surrounding structures after implantation and are often not of the correct size - especially regarding length - with poor compliance (elasticity). For mentioned reasons we do not use them in reoperations. In this cases we choose such a sling which is properly fixed to the surrounding structures, is of sufficient length, and of appropriate elasticity. When choosing the right type of procedure we also have to consider previous operations: for example, whether reconstructive surgery of pelvic floor defects using mesh has been carried out, where the mesh has been placed, and whether it might be an obstacle to the newly implanted sling. If there is a low urethral mobility after the unsuccessful incontinence operation and a low MUCP is observed on urodynamic examination, then we prefer either a retropubic sling or the application of a bulking agent. The decision of which method to choose also depends on other circumstances, such as whether the patient has undergone radiation treatment or more than on previous surgery to treat SUI. The results of urodynamic, ultrasound and other examinations are very important.
  
  
  CONCLUSIONS
  The choice of the right type of surgery to treat SUI after a previous failed procedure depends on information and findings from complex examination of the patient. Case history, examination results, imaging and the experience of the surgeon in individual procedures are therefore most important.
authors.forename: A
authors.initials: A
authors.lastname: Martan
authors.forename: J
authors.initials: J
authors.lastname: Mašata
authors.forename: K
authors.initials: K
authors.lastname: Švabík
mesh_terms: D000180:Acrylic Resins / Q000627:therapeutic use*; D001672:Biocompatible Materials / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020100:Hydrogels / Q000627:therapeutic use*; D017773:Pelvic Floor / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D053825:Suburethral Slings; D013526:Surgical Mesh; D017211:Treatment Failure; D014463:Ultrasonography; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods
chemical_list: D000180:Acrylic Resins; D001672:Biocompatible Materials; C528271:Bulkamid; D020100:Hydrogels
keywords: anti-incontinence surgery Bulkamid.; stress urinary incontinence