Secondary colposuspension: results of a prospective study from a tertiary referral centre

Abstract

OBJECTIVE: To evaluate the results of secondary colposuspension in women with recurrent urinary stress incontinence. DESIGN: Prospective cross sectional observational study. SETTING: Tertiary referral urogynaecology unit. POPULATION: Fifty-six women with recurrent stress incontinence. MAIN OUTCOME MEASURES: Determine prognostic factors that may affect the outcome of surgery, long term subjective and objective success rates and identify complications of secondary colposuspension. RESULTS: The mean age was 54 years (range 34-83) and the median parity was 3 (range 1-5). The median length of follow up was four years (range 1.01-7.07). Forty-two (75%) women had genuine stress incontinence and 14 (25%) had mixed incontinence on subtracted cystometry. The subjective cure rate was 71% and the objective cure rate was 80% and, as per Kaplan-Meier life time analysis, 65% had not failed surgery five years after the operation. The complication rate was low. However at follow up, eight women had required a posterior colporrhaphy for rectocele and three had a sacrocolpopexy for vault prolapse. Another eight women required further treatment for stress incontinence (seven urethral bulking agents and one tension-free vaginal tape). There was no correlation of the outcome to age, past hysterectomy, number of previous incontinence procedures, parity, body mass index or blood loss at operation. CONCLUSION: Colposuspension after failed continence surgery has a good outcome with a low complication rate, but many still require further surgery for prolapse.