Therapy of persistent or recurrent stress urinary incontinence

After synthetic sling procedures, up to 16 % of women and 45.5 % of men complain about a persistent or recurrent stress urinary incontinence (SUI). Currently, randomized studies comparing the different treatment modalities of persistent or recurrent SUI are lacking. There are data of retrospective studies investigating the efficiency of synthetic slings and the artificial urinary sphincter AMS 800A (R) in men. Synthetic slings can be applied in patients with mild SUI and without prior radiation of the pelvic region. The AMS 800A (R) is the treatment of choice in patients with severe SUI or previous radiation. In women with persistent and recurrent SUI, the efficiency of colposuspensions, autologous and synthetic slings as well as the AMS 800A (R) has been investigated in retrospective studies. Due to comparable cure rates and a faster postoperative recovery, synthetic slings are now superseding colposuspensions and autologous slings. Excellent success rates after AMS 800A (R) implantation have been described for both genders; nonetheless, postoperative complications and revisions as well as the requirement of dexterity of the patients should be taken into account. Data about the efficiency of adjustable slings, the ACTA (R) and newer artificial urinary sphincter devices like Flow-SecureA (R) and ZephyrA (R) ZSI 375 in the treatment of persistent and recurrent SUI is lacking.