Cramer MS, et al. - The rate of recurrent stress urinary incontinence (SUI) following sling revision in addition to the risk factors for recurrence was determined in this study. In this study, complete excision of sling was more frequently performed on women with pain which was associated with a higher rate of recurrent SUI in this group. As per other studies, patients who underwent partial vs complete excision were similar in terms of rates of pain resolution following revision. They suggested counseling patients with pain to undergo partial excision of a sling as reasonable to attempt to reduce the risk of postoperative recurrent SUI.

Methods

• Researchers used the CPT code 57287 to retrospectively collect data on 160 patients aged 18 to 100 years who underwent mesh sling revision between January 2009 and July 2016 with a urogynecologist at Christiana Care Hospital.
• They excluded patients who underwent revision of vaginal mesh or mesh used for prolapse repair, sling adjustment for persistent SUI, if stress incontinence never resolved prior to sling revision, or who had missing data.
• They used chi-square test and student’s t-test for performing data analysis.
• At p < 0.05, statistical significance was set.
• They used multiple logistic regression analysis to control for variables that may influence differences in outcomes.

Results

• The inclusion criteria was met by 129 women.
• Researchers noticed an average follow-up period of 21 months (range <1 month to >95 months).
• Any return of SUI after sling revision was defined as recurrence of stress incontinence.
• Findings revealed an overall recurrence rate of 39.5% (n = 51 of 129 patients).
• Recurrence was more frequent among women who presented with pain (dyspareunia, pelvic pain, or muscle spasm) (OR = 23.6, 95% CI = 1.5-367.1, p=0.02) as compared with women who presented for sling revision due to erosion or voiding dysfunction.
• Recurrence was less frequently observed among patients >55 years old at time of sling revision (OR = 0.14, 95% CI = 0.04-0.53, p=0.02).
• A higher SUI recurrence rate (82.4%) was evident among patients whose original slings were placed >1 year prior to revision of the sling than those whose sling was placed <1 year prior to revision (17.7%) (p=0.02).
• Complete excision of the sling was more frequently observed among women with pain as initial symptom (30% complete excision, 12.4% partial excision, 4.8% transection, p=0.03).
• Overall, higher rates of recurrent SUI were not observed among women who underwent complete excision vs partial excision/transection of prior sling post-operatively (42.9% vs 38.6%, p=0.68).
• However, recurrent SUI was evident in 70% (n = 14) of women who underwent revision of sling for pain compared to 33.9% (n = 37) of women who underwent revision for other indications.
• A higher rate of recurrent SUI was evident among women with pain vs without pain who underwent complete excision of sling (30% vs 10.5%, p=0.016) when controlling for the symptom of pain.
• In the subgroup of women who underwent excision for pain, length of sling excised was not markedly different.
• With complete excision, patients with voiding dysfunction showed a lower rate of recurrent SUI compared with other methods of revision (33.3% vs 57.14%, p=0.02).