Suburethral sling procedures after previous surgery for urinary incontinence or pelvic organ prolapse

Abstract

Objective. To compare the outcome of suburethral sling procedures (tension-free vaginal tape (TVT), obturator
tape (Ob-tape)) for stress urinary incontinence (SUI) in women with previous surgery for SUI or pelvic organ
prolapse (POP).
Methods. A comparative, descriptive, retrospective study was done using information drawn from a
urogynaecological database of 195 women with urinary incontinence. We divided 195 women into a group
with previous surgery for urinary incontinence or POP (study group, N = 106) and a group without previous
incontinence surgery (control group, N = 89). All women underwent a TVT (86%) or Ob-tape procedure (14%).
The mean follow-up in the study group was 25 months (range 2 - 61 months) and in the control group 24 months
(range 1 - 49 months). Since a urodynamic evaluation facility was not available for most women, the diagnosis
of SIU and other types of incontinence was made clinically.
Results. On admission 43 women in the study group presented with SUI (40.6%), compared with 34 in the
control group (38.2%) (95% confidence interval (CI) -11.3%; 15.7%). Urge incontinence was present in 10 women
in the study group (9.4%) and 6 in the control group (6.7%) (95% CI –5.7%; 10.6%). Mixed incontinence was
present in 47 (44.3%) of the study group and 39 (43.8%) of the control group (CI –13.3%; 14.2%). The diagnosis
was unknown in 6 women in the study group and 10 in the control group.
Following surgery, SUI recurred in 25 (23.6%) women in the study group and 12 (13.5%) in the control group (95%
CI –1.0%; 20.6%). Overactive bladder symptoms were present postoperatively in 43 women in the study group
women (40.6%) and 39 controls (43.8%) (95% CI –16.9%; 10.4%).
Follow-up surgery was performed in 14 women in the study group (13.2%) and 6 controls (6.7%) (95% CI –2.4%;
15.0%). Included were mesh removals (4 study group, 1 control), Burch colposuspension (1 and 2, respectively),
and TVT or Ob-tape (2 and 1, respectively).
Conclusion. Statistically, previous surgery was not a risk factor for recurrent SUI, but a tendency was observed
towards more SUI in these women.

South African Journal of Obstetrics and Gynaecology Vol. 13 (2) 2007: pp. 64-67