Low retreatment rates observed for SUI procedures

September 17, 2013

Three different procedures to treat stress urinary incontinence led to high rates of recurrence-free outcomes at 5 years, and the choice of retreatment of SUI varied according to the initial procedure, long-term follow-up in two randomized trials showed.

Dallas-Three different procedures to treat stress urinary incontinence (SUI) led to high rates of recurrence-free outcomes at 5 years, and the choice of retreatment of SUI varied according to the initial procedure, long-term follow-up in two randomized trials showed.

The 5-year retreatment-free survival ranged between 87% and 95% for the Burch, autologous fascial sling, and midurethral sling procedures. For retreatment procedures, the fascial sling and injectable therapy accounted for most of the procedures, researchers reported at the AUA annual meeting in San Diego.

“The 5-year retreatment-free survival was high. There was no consistent relationship between the MESA [Medical, Epidemiological, and Social Aspects of Aging] stress index and choice of surgery or injection therapy for retreatment,” said first author Philippe Zimmern, MD, professor of urology at the University of Texas Southwestern Medical Center in Dallas.

Management of recurrent SUI remains controversial, and several options exist for treatment of recurrent urine leakage. Injection therapy with a bulking agent and synthetic or autologous fascial sling procedures have demonstrated safety and efficacy. Additionally, injection therapy can be used in combination with a sling procedure.

To examine long-term outcomes after treatment of SUI and retreatment decisions for recurrent SUI, Dr. Zimmern and colleagues reviewed long-term experience with the Burch, autologous fascial sling, and midurethral sling procedures. They performed a secondary analysis of data from two extended clinical trials conducted by the Urinary Incontinence Treatment Network: the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) and the Trial of Midurethral Slings (TOMUS).

SISTEr and TOMUS had similar designs, including enrollment of patients with no prior treatment for SUI and no prior anterior prolapse repair procedure or hysterectomy as a concomitant surgery. The MESA stress index was used as a measure of treatment success.

In the subgroup of patients who required retreatment, the MESA index was compared to retreatment from the perspective of original type of surgery and by the type of retreatment (surgery vs. injection).

Dr. Zimmern presented data from an analysis of 228 patients from the SISTEr study (119 treated by Burch procedures and 109 by sling) and 311 patients from TOMUS (156 by transobturator sling and 155 by retropubic sling).

31 patients required retreatment

Overall, 31 patients required retreatment, consisting of 17 from the Burch subgroup, three from the fascial sling subgroup, and 15 from the midurethral sling subgroup. The 5-year retreatment-free survival rate was 87% with the Burch procedure, 93% with midurethral sling, and 95% with fascial sling.

In the Burch subgroup, retreatment consisted of fascial slings in eight cases and injectable therapy in nine. The three patients requiring retreatment in the fascial subgroup had fascial sling, synthetic sling, and injection therapy in one case each. In the midurethral sling subgroup, eight patients had fascial slings for retreatment and seven had injectable agents. Four patients (three in the Burch subgroup and one in the midurethral sling subgroup) had both surgery and injectable therapy for retreatment.

The investigators found no association between 100-point MESA index score, initial treatment for SUI, and type of retreatment. Patients who initially had Burch procedures had MESA scores of 40-41 at retreatment. Of those who initially underwent midurethral sling procedures, the MESA score averaged 70.3 for patients who had slings as retreatment and 55.3 for those who received injectable therapy. Of the patients who had fascial slings as initial treatment, the MESA score was 44.0 in the patients who had sling procedures for retreatment and 89.0 for retreatment with injectable collagen.UT

 

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