Pros and Cons of Urinary Slings

Stress urinary incontinence leakage not improved in women with repeat sling procedures

(RxWiki News) If it didn't work the first time, women who get urinary slings to control their bladder can certainly try the procedure again. The second or third time might be a charm, but not all outcomes with the new slings benefit its user.

Urethral slings are designed to support the tube controlling urine flow. 

Though women had improved quality of life with multiple sling procedures, the new slings were almost twice as likely to fail at controlling the bladder, according to a recently published study.

Based on these findings, health professionals can show patients that slings may improve their well-being. However, additional therapies may be needed to improve bladder control.

"Running to the bathroom? Talk to a doctor."

The study, led by Alison Parden, PhD, MD, from the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham, looked at how well repeat sling procedures addressed stress urinary incontinence (SUI) and other urinary tract issues.

More than 1,300 patients were surveyed on their urogenital distress and symptoms. Researchers tracked the number of patients who no longer had symptoms or who had their symptoms "somewhat" improved.

Only 61 percent of the surveys were returned. Among the returned surveys, 92 patients (10 percent) had undergone a midurethral sling procedure previously.

In the procedure, a sling is placed into the middle of the urethra (the tube that connects the bladder to outside the body) to support bladder control. Patients with SUI have weaker urethras that cannot control urine as well.

Researchers found that women who had a repeat sling procedure were almost twice as likely to report that the sling failed to stop their SUI symptoms.

The failures may be due to neuromuscular injuries or problems with their first sling procedure, according to the researchers.

Symptoms related to quality of life, however, significantly improved among women who had a second procedure compared to women who had just one.

"Women undergoing repeat midurethral sling procedures have significantly lower SUI cure rates than do those undergoing primary midurethral sling procedures, making them almost twice as likely to report failure," researchers wrote in their report.

"Despite this, women who underwent repeat midurethral sling procedures had greater improvement in symptom-specific effect on quality of life and reported similar satisfaction and impression of improvement compared with those undergoing primary midurethral sling procedures."

Specifically, 71 percent of the patients who had just one sling procedure had little to no leakage and stronger bladders. Only 54 percent of patients who had a repeat sling procedure had similar improvements.

Researchers noted that some of the participants' medical records were incomplete and the results may be subject to bias since not all the surveys were returned.

The study, which was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, was published in the February issue of Obstetrics & Gynecology.

One of the authors received research grants from Pelvalon, Astellas, Warner Chilcott, University of California and Pfizer and was also a consultant to Astellas, GlaxoSmithKline, Uromedica, IDEO, Pfizer and Xanodyne.

Reviewed by: 
Review Date: 
February 20, 2013