Treatment of recurrent stress urinary incontinence in women after a failed suburethral tape operation

Stress urinary incontinence (SUI) is loss of urine when a person coughs or exercises. Damage to the pelvic floor muscles and injuries to the nerves during childbirth may lead to SUI. Simple treatments, such as exercising the muscles in the pelvic floor or drugs (medication), may be tried at first. If these methods have not worked, surgery is often performed. This usually involves placing a tape made from polypropylene (a synthetic material, like nylon, that is used in some surgical stitches and other medical devices) underneath the neck of the bladder. This operation is very successful but not all women will be cured after a first tape surgery, and there is currently no agreement among experts on how to treat women with persistent or recurrent problems. This review set out to find evidence for different treatments, but it did not identify any studies which provided answers. High quality randomised clinical trials are urgently needed to answer this question.

Authors' conclusions: 

There were no data to recommend or refute any of the different management strategies for recurrent or persistent stress incontinence after failed suburethral tape surgery. Evidence is urgently required to address this deficiency, ideally from RCTs.

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Background: 

Surgery is a common treatment modality for stress urinary incontinence (SUI), usually offered for women who fail conservative treatments. Suburethral tapes have superseded colposuspension because cure rates are comparable and recovery time reduced. However, some women will not be cured after suburethral tape surgery, and currently there is no consensus on how to manage these women.

Objectives: 

To obtain and examine evidence supporting different management strategies for recurrent/persistent stress urinary incontinence (SUI) in women after failed suburethral tape surgery.

Search strategy: 

We searched the Cochrane Incontinence Group Specialised Register of controlled trials (searched 18 December 2012), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and PreMEDLINE; and handsearched journals and conference proceedings, and the reference lists of included studies and previous Cochrane reviews for randomised or quasi-randomised studies treating patients with recurrent incontinence, either as the sole population or a subset. Conservative, medical and surgical treatments were included.

Selection criteria: 

We included randomised and quasi-randomised controlled trials in women who had recurrent urinary incontinence after previous minimally invasive suburethral tape surgery.

Data collection and analysis: 

Abstracts of identified studies were checked by two authors to confirm eligibility. Full text reports of relevant studies were obtained, and authors were contacted directly where necessary. Outcome data were extracted onto a standard proforma and processed according to the methods in the Cochrane Handbook for Systematic Reviews of Interventions.

Main results: 

Twelve studies were identified, but all were excluded because they did not meet the eligibility criteria. Six were randomised controlled trials (RCTs) but were not eligible because the previous incontinence surgery was not a suburethral tape. A subset of one RCT may have been eligible for inclusion because some of the women were having repeat surgery, but we were unable to obtain from the authors the data according to primary surgery for this cohort.

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