Colposuspension after previous failed incontinence surgery: a prospective observational study

OBJECTIVE: To evaluate the outcome of colposuspension for genuine stress incontinence in women who had previously undergone bladder neck surgery. DESIGN: Prospective observational study. SETTING: Tertiary referral urogynaecology unit. PARTICIPANTS: Fifty-two consecutive women with recurrent genuine stress incontinence operated on by one surgeon. MAIN OUTCOME MEASURES: Subjective and objective cure of stress incontinence. Complications of surgery. RESULTS: The mean age of the women was 51 years (range 28-72) and weight 72.7 kg (range 53-112). Sixty-five continence procedures had been performed previously, with 13 women (25%) having had more than one operation. Nine months post-operatively the subjective cure rate was 80% and objective cure rate 78%. Intraoperative complications were few but included two bladder injuries and one rectus muscle tear which required repair. Seven women (13%) developed voiding difficulties which required clean intermittent self-catheterisation, but only one needed to continue this for six months. None of the women developed detrusor instability. CONCLUSIONS: In this setting colposuspension after previous bladder neck surgery offers a high rate of success. However, long term follow up is needed to see if this effect is maintained.