Presentation Authors: Dayron Rodriguez*, Deborah Hess, Feras Alhalabi, Timothy Carroll, Maude Carmel, Philippe Zimmern, Dallas, TX
Introduction: Following suburethral sling removal (SSR) for synthetic sling complications, stress urinary incontinence (SUI) may occur in up to 59% of patients(1). Our study sought to evaluate outcomes following urethral Macroplastique (MPQ) injection in women with SUI following sub-urethral sling removal (SSR).
Methods: Following Institutional Review Board approval, charts of non-neurogenic women with SUI secondary to intrinsic sphincter deficiency (ISD) after SSR who underwent MPQ injection were reviewed from a prospectively maintained database. Patients with follow-up less than 6 months were excluded. Baseline data included UDI-6 and VAS Quality of Life (QoL) Questionnaire scores. Patients were followed with repeat questionnaires and three-dimensional ultrasound (3D US) evaluating volume of MPQ. Success following MPQ was defined as a composite score of self-reported improvement of more than 70%, usage of less than 2 pads/day, a UDI-6 question 3 score of 0-1, a VAS QoL score of less than 3, and no additional anti-incontinence therapy.
Results: From 2011-2018, 70 women with mean age of 62.7 years met study criteria. At a mean follow-up of 46.4 Â± 1.5 months, the success rate after a first MPQ injection was 41% (29/70). Of the 41 patients who failed initial injection, 27 underwent a repeat injection with a success rate of 52%. Therefore, the overall success rate for the entire cohort was 61% (43/70). Of the 13 patients who failed a second MPQ injection, 11 had stable MPQ volume on 3DUS (mean volume 8.43 +/- 0.72ml). Four of these patients underwent autologous pubovaginal sling placement (PVS) to treat residual ISD with resolution of SUI. Of those who did not seek a second injection, 11 sought no further treatment while 2 underwent autologous PVS placement. The majority of patients who failed MPQ injection reported subjective improvement and reduced pad usage. Higher parity was associated with MPQ failure (p=0.027).
Conclusions: Macroplastique injection is an effective management for SUI following sub-urethral sling removal, although a second injection may be required to achieve success. These results highlight that most incontinent women can maintain favorable urinary control with a minimally invasive procedure following SSR.