The surgical management of recurrent stress urinary incontinence: a systematic review

BackgroundDespite a wide spectrum of interventions, surgical treatments of recurrent stress urinary incontinence (SUI) are associated with high failure rates. ObjectivesTo systematically review current evidence on the effectiveness of surgical interventions for recurrent SUI. Data sourcesAn electronic database search was undertaken (1980-2014). Keywords were: stress urinary incontinence, failure, recurrence, treatment. References of identified studies and abstracts from conferences were considered. Study selectionWe restricted the search to female patients and currently used surgical procedures, including studies with five or more cases. After the initial yield, studies were selected following title screening, abstract and full text scrutiny. ResultsThe pooled objective cure rates of colposuspension for recurrent SUI are 76% (95% CI 5.04), whereas rates for midurethral sling procedures are 68.5% (95% CI +/- 3.11). Repeat midurethral sling procedures have pooled success rates of 66.2% (95% CI +/- 4) but those of the transobturator approach appear lower than retropubic procedures. Pubovaginal slings for recurrent SUI have pooled success of 79.3% (95% CI +/- 6.54). Success rates for adjustable continence therapy and adjustable slings for recurrent SUI are 53.8% (95% CI +/- 5.28), whereas for midurethral sling fixation procedures the pooled success is 61% (95% CI +/- 10.56). Urethral bulking injections have success rates of 38% (95% CI +/- 10.7). Laparoscopic two-team sling procedures, salvage spiral slings, and artificial urinary sphincter have shown promising results, but there are limited data on recurrent cases. ConclusionThere is a wide spectrum of surgical interventions reported for secondary or tertiary treatment of SUI. A common characteristic for all recurrent procedures is a lower success rate compared with those reported following primary procedures.