Surgical Management of the Failed Anti-incontinence Surgery / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Various surgical methods have been using to treat female stress urinary incontinence. However, significant numbers of those patients suffered from immediate or delayed recurrences. The aims of this study were to analyze the etiology of recurrent stress urinary incontinence and evaluate the efficacy of each operation which was used as methods of treating recurrent stress urinary incontinence. MATERIALS AND METHODS: Data of 16 female patients with recurrent stress urinary incontinence who visited and treated at our urologic department from January 1995 to March 1998 were analyzed. All patients were assessed for their age, types of previous and current anti-incontinence operations, urodynamic findings and final outcomes. RESULTS: Mean age was 48.8 years old. 12 patients were taken anti-incontinence operations only once before recurrence, and 4 patients experienced two times of anti-incontinence operations. Two of 16(12%) patients were diagnosed as anatomic incontinence(AI), 3(19%) patients were diagnosed as intrinsic sphincteric dysfunction(ISD), and 11(69%) patients had both AI and ISD. Two AI patients were finally managed by Raz bladder neck suspension with anterior and posterior colporrhaphy(APR), and Burch colposuspension, respectively. Three ISD patients were treated by sling operation & APR, collagen injection, and Burch colposuspension, repectively. 11 mixed incontinence patients were treated by sling operations & APR(7), Burch colposuspension(3), Stamey`s needle suspension & APR(1). None of 16 patients has developed recurrent urinary incontinence so far. CONCLUSIONS: Basic principle in treating AI is the correction of the urethral hypermobility. However, 81%(13/16) of patients still had urethral hypermobility in spite of previous anti-incontinence surgery, and it seems that those anti-incontinence surgeries were improperly selected or urethral hypermobility reappeared. Patients who showed urinary incontinence in spite of well supported bladder neck suggest the possibility of undetected or secondary ISD. These findings support the importance of selection of proper initial surgical management. In recurrent urinary incontinence, majority of them show undetected or newly appeared ISD component regardless of urethral hypermobility. In those situations, sling operation can be a safe and effective procedure in the management of patients with failed anti-incontinence surgery.