Treatment of recurrent stress urinary incontinence in women | Figure 1

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

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Review question

What is the best way to treat women whose stress urinary incontinence is not cured or recurs after surgery to insert a tape underneath the bladder outlet (midurethral tape)?

Background

Stress urinary incontinence (SUI) is the loss of urine when a person coughs or exercises. It can be caused by damage to the pelvic floor muscles or their nerve supply, particularly during childbirth. Simple treatments, such as exercising pelvic floor muscles or medication, may be tried at first. If these methods have not worked, surgery is often performed, which can be done using a midurethral tape. 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 bladder outlet. This operation is usually very successful, but not all women will be cured. There is currently no agreement amongst experts on how to treat women with recurrent stress urinary incontinence problems following unsuccessful midurethral tape surgery.

How up‐to‐date is this review?

The evidence is current up to 9 November 2018.

Study characteristics

Our search identified one study for this review, including a total of 341 women. Of these, just 46 women met our inclusion criteria by having undergone previous continence surgery with a midurethral tape or colposuspension (a type of surgery used to support the tissues around the neck of the bladder with stitches). This review only focused on the results from these 46 women, extracted from the overall trial results.

Study funding sources

The one included study was funded by the Henry Smith Charity. A published correction indicated commercial support from the manufacturer of a device used in the study, which could be a source of bias.

Key results

We wanted to assess the effects of conservative treatment (such as pelvic floor muscle training or bladder training), surgery and medication on the number of women who reported that their incontinence was improved or cured after treatment, along with other outcomes such as quality of life and adverse events. We were also interested in the effects on our outcomes of different types of midurethral tapes.

Of the 46 eligible women in the included study, two‐thirds were reported to have received a midurethral tape in their first surgery. However, the data in the report did not differentiate between women who had previously undergone surgery with a midurethral tape and those who had had colposuspension. This means that we cannot be certain that the results were due to the midurethral tape, so we could not use the data in this review.

We planned to summarise evidence about which treatments might be considered worthwhile uses of healthcare resources but we did not identify any studies that asked this question.

Certainty of the evidence

The lack of useable data means that we were unable to assess the certainty of the body of evidence.

Authors' conclusions

We did not find enough data to accurately assess the effects of any of the different management strategies for recurrent or persistent stress incontinence after failed midurethral tape surgery. Evidence from high‐quality studies is required to address this area of uncertainty.

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