Recurrent stress urinary incontinence in women: results of surgical reinterventions

Introduction. The efficiency of surgical treatment of stress urinary incontinence (SUI) in women is 77-85%, and in nearly 15% of cases repeated procedures are required.

Aim. To present the experience of our center in the treatment of recurrent SUI in women and to evaluate the efficiency of repeated interventions.

Materials and methods. The retrospective study included women with recurrent SUI. They underwent to mid-urethral sling procedure or Burch colposuspension. The preoperative data, objective assessment of urinary incontinence and previous interventions were analyzed. Postoperatively, the presence of SUI, the degree of urinary incontinence and the quality of life were assessed. Data on additional surgical procedures was collected at a follow-up visit.

Results. A total of 179 patients underwent correction of SUI. Data on 10 patients with recurrent SUI were included. The age of the women was from 32 to 74 years (median 65 years, IQR 28), and one of them had a hysterectomy. Before our interventions, 9 patients underwent a single surgical procedure for SUI and one had previously had three interventions in other clinics. In general, there were 12 previous operations, including urethropexy with tension-free vaginal tape-obturator (TVT-O) (7/12), urethropexy with tension-free vaginal tape (TVT) (1/12), laparoscopic Burch colposuspension (1/12) and urethropexy with a synthetic loop with unspecified approach (3/12). At the time of the first examination, the women used 2-6 pads per day. The following types of treatment were performed in our center: 5 patients underwent retropubic urethropexy with tension-free vaginal tape (TVT) and 4 patients had laparoscopic Burch colposuspension. In addition, 2 simultaneous laparoscopic revision of the Retzius space and TVT under laparoscopic guidance were performed as well as one simultaneous open Burch colposuspension and TVT.

The median follow-up after surgery was 6 months. In two out of 10 patients (after primary TVT and TVT-O), laparoscopic Burch colposuspension was not effective. A recurrence of SUI was detected in the postoperative period. Then, the patients underwent revision of the Retzius space and TVT under laparoscopic guidance and open Burch colposuspension and TVT, respectively. Postoperatively, urinary continence was restored. Complete urinary continence (0 pads per day) was achieved in 50% of cases (6 out of 12 procedures). In three women (25%) mild SUI remained (2-4 points on the ICIQ-SF, 1 safety pad per day); at the same time, they noted a significant improvement in their quality of life. Thus, repeated interventions were effective in 75% of cases (9 out of 12). According to the evaluation of urination disorders (UDI-6), five patients had minor symptoms (1-3 points). Most of them сcomplained of frequent urination that did not affect the quality of life.

Conclusions. The efficiency of surgical treatment of recurrent SUI was 75%. The most often subsequent procedures were TVT and Burch colposuspension, as well as their combinations.