There is no clinical consensus concerning the best surgical procedure for recurrent stress urinary incontinence (rSUI) after primary mid-urethral sling (pMUS). The aim of this meta-analysis was to evaluate efficacy and safety of repeated MUS (rMUS) in women previously submitted to pMUS.
We performed systematic research and meta-analysis from PubMed/MEDLINE and EMBASE, according to PRISMA 2020 guidelines, until 11th of November 2024. Women with rSUI after pMUS, submitted to rMUS were included. Primary- versus repeated-MUS and retropubic (RP) versus transobturator (TO) approach were compared. rSUI cure and re-operation rates were evaluated. Seventeen articles were included. KEY FINDINGS AND LIMITATIONS: rMUS subjective and objective success rates were 68 % (95 %CI: 62 %-74 %; I2-test 70.3 %, p < 0.001) and 74 % (95 %CI: 66 %-82 %; I2-test 61.4 %, p = 0.003) respectively. No difference emerged between RP and TO approach subjectively [OR 0.92, 95 %CI 0.52-1.64; p = 0.78 (I2-test 34 %, p = 0.18)] and objectively [OR 0.80, 95 %CI 0.03-23.62; p = 0.90 (I2-test 79 %, p = 0.03)]. No difference was highlighted between pMUS and rMUS [OR 0.42, 95 %CI 0.16-1.09; p = 0.08 (I2-test 78 %, p = 0.03)] in subjective cure. No severe adverse events were reported. Reoperation rate for any indication was 5 % (95 %CI: 1 %-9%; I2-test 56.9 %, p = 0.04). Reoperation rate for rSUI was 1 % (95 %CI: 0 %-2%; I2-test 0.24 %, p = 0.37). Reoperation rate for other indications was 3 % (95 %CI: 1 %-4%; I2-test 10.9 %, p = 0.34).
rMUS is a highly effective and safe option for women with rSUI. Its excellent effectiveness, comparable to that of pMUS, and the lack of significant differences between RP and TO techniques underscore the flexibility and validity of this approach.
European journal of obstetrics, gynecology, and reproductive biology. 2025 Feb 18 [Epub ahead of print]
Alessandro Ferdinando Ruffolo, Tomaso Melocchi, Matteo Frigerio, Chrystele Rubod, Yohan Kerbage, Xavier Deffieux, Marine Lallemant, Michel Cosson
CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France. Electronic address: ., CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Department of Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy., Department of Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy., CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ Lille, CHU Lille, ULR 2694 - METRICS, F-59000 Lille, France; Univ. Lille, CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle F-59000 Lille, France., CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ Lille, CHU Lille, ULR 2694 - METRICS, F-59000 Lille, France; Univ. Lille, Unité Inserm U1189 - OncoThai : Laser Assisted Therapies and Immunotherapies for Oncology, 59000 Lille, France., Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France., CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Department of Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Université de Franche-Comté, Department of Applied Mechanics, FEMTO-ST Institute, UMR 6174 CNRS, F-25000 Besançon, France.