Short Interval Repeat Midurethral Sling for Stress Incontinence: Single Institution Experience

Objectives: The primary objective of this study was to describe subjective outcomes in women who reported persistent stress urinary incontinence (SUI) following an index midurethral sling (MUS) and chose to undergo a short interval repeat MUS. Secondary outcomes were to compare patient satisfaction and retreatment between groups.

Methods: This was a retrospective cohort study of patients who reported persistent SUI following an index MUS and chose to undergo a repeat MUS within 1 year at a tertiary care referral center from 2016 to 2022. Subjects were identified using Current Procedural Terminology codes. Demographics and clinical outcomes were abstracted from medical records.

Results: Thirty-seven women underwent repeat MUS within 1 year of index MUS and met inclusion criteria. Persistent SUI was defined by patient symptoms and positive cough stress test. Women with prior history of anti-incontinence procedure, concomitant non-gynecologic surgery, absence of baseline stress incontinence symptoms, and repeat sling for mesh exposure were excluded. Of the study cohort, 21 (57%) women had repeat MUS at ≤ 6 weeks from index MUS and 16 (43%) had repeat MUS at > 6 weeks ≤ 52 weeks from index MUS; all index and repeat MUS were retropubic midurethral slings. Twenty-four women (65%) underwent isolated MUS for index surgery while remainder had concomitant procedures. Patient reported cure rate was defined as an answer of “not present” or “not at all” to question 3 on the UDI-6 questionnaire. Composite success was also determined by aforementioned UDI-6 question 3 score and score of “very much better” or “much better” on the PGI-I. Postoperative questionnaire data were available in 57% of patients (n=21). There was no difference in patient reported success rates by UDI-6 question 3 (77% in repeat MUS at ≤ 6 weeks vs 63% in repeat MUS at > 6 and ≤ 52 weeks) or in composite success (64% in repeat MUS at ≤ 6 weeks vs 50% in repeat MUS at > 6 and ≤ 52 weeks). Satisfaction on the PGI-I and on the satisfaction with decision score scales were high across both groups. Persistent SUI symptoms after repeat MUS were more common in the ≤ 6 week group (40% vs 6%, p=0.026) but retreatment after repeat MUS was similar across both groups (19% vs 13%, p=0.68).

Conclusions: Short term repeat MUS for persistent SUI can be performed either within 6 weeks or after 6 weeks from index MUS with similar improvement in symptoms. Timing of repeat MUS is not independently associated with patient reported cure rates or patient satisfaction. The decision of when to repeat a MUS for persistent SUI should therefore be determined on an individual basis, taking the patient’s goals and preferences into consideration.