Sling plication for failed midurethral sling surgery to treat female stress urinary incontinence

Introduction: Stress urinary incontinence (SUI) is a common problem in women. When conservative therapy fails, surgical interventions should be considered. Midurethral slings (MUSs) were introduced in the 1990s and have been the golden standard for surgical treatment of SUI. Despite being the golden standard among several different surgical options for SUI, failure rates vary from 8% to 57%. There is no defined standard of care after failed MUS. Sling plication is a less invasive procedure compared to other surgical options, however data is relatively scarce. Methods: Three women who underwent sling plication for persistent SUI after retropubic MUS were identified. Sling plication was performed by the same physician. The polypropylene sling was isolated and cut medially. Sling ends were then folded over each other and fixated with prolene sutures. Tensioning of the sling was based on the subjective assessment of the surgeon. Subjective and objective findings were collected before initial placement of MUS, after placement of MUS and at six and twelve weeks after plication of MUS. Results: All three women had a satisfactory reduction of SUI symptoms after sling plication. Reduction in pad use was clinically relevant, decreasing from two to six large pads to a maximum of two small pads a day. There were no post-operative complications. All women would recommend sling plication to others in the same situation. Conclusion: Sling plication is an effective, safe and less invasive way of treating persistent or recurrent SUI after midurethral sling surgery and should be considered when counselling patients after failed MUS. Further research with bigger study populations, standardised methods to quantify improvement after plication and longer follow-up is needed to verify our positive results.