Is obstruction an issue after adjustable sling insertion for recurrent stress urinary incontinence?

Objective: The aim of this prospective study was to evaluate the feasibility, efficacy and outcome of an adjustable sling system (AMI) in women with recurrent stress urinary incontinence after failed midurethral tape.

Patients and methods: 106 women with recurrent urinary stress incontinence with an adjustable tape inserted were analysed for feasibility, efficacy and outcome. Primary outcome was the micturition pressure (pdet/Qmax) during pressure flow study; secondary outcomes were residual urine, bladder neck mobility and adjustment time as well as continence., Subjective outcome and patient satisfaction was quantified using the Visual Analogue Scale (VAS).

Results: 106 women underwent an adjustable sling system AMI. Obstructive voiding pressure was seen in one patient. Detrusor pressure at maximal flow (pdet/Qmax) increased significantly as did the maximal urethral closure pressure (MUCP).

Mean time of adjustment was 2.8 (SD+/- 1.85) days with a mean follow-up of 24 (SD +/- 20) months. 75 (70.1%) women were continent, 31 patients with a positive PAD weight test and 15 with persisting stress urinary incontinence with a positive cough test. Patient satisfaction improved significantly.

Conclusion: Adjustable midurethral tape in women with recurrent stress urinary incontinence is a feasible and effective treatment option in women with complex stress urinary incontinence who have failed a previous midurethral sling. Obstruction may occur but is infrequent.