Efficacy and safety of repeated synthetic mid-urethral sling for recurrent stress urinary incontinence: A systematic review and metanalysis

Introduction There is no clinical consensus concerning the best surgical procedure for recurrent stress urinary incontinence (rSUI) after primary mid-urethral sling (pMUS). The aim of this meta-analysis was to evaluate efficacy and safety of repeated MUS (rMUS) in women previously submitted to pMUS. Methods We performed systematic research and meta-analysis from PubMed/MEDLINE and EMBASE, according to PRISMA 2020 guidelines, until 11th of November 2024. Women with rSUI after pMUS, submitted to rMUS were included. Primary- versus repeated-MUS and retropubic (RP) versus transobturator (TO) approach were compared. rSUI cure and re-operation rates were evaluated. Seventeen articles were included. Key findings and limitations rMUS subjective and objective success rates were 68 % (95 %CI: 62 %-74 %; I-2-test 70.3 %, p < 0.001) and 74 % (95 %CI: 66 %-82 %; I-2-test 61.4 %, p = 0.003) respectively. No difference emerged between RP and TO approach subjectively [OR 0.92, 95 %CI 0.52-1.64; p = 0.78 (I-2-test 34 %, p = 0.18)] and objectively [OR 0.80, 95 %CI 0.03-23.62; p = 0.90 (I-2-test 79 %, p = 0.03)]. No difference was highlighted between pMUS and rMUS [OR 0.42, 95 %CI 0.16-1.09; p = 0.08 (I-2-test 78 %, p = 0.03)] in subjective cure. No severe adverse events were reported. Reoperation rate for any indication was 5 % (95 %CI: 1 %-9%; I-2-test 56.9 %, p = 0.04). Reoperation rate for rSUI was 1 % (95 %CI: 0 %-2%; I-2-test 0.24 %, p = 0.37). Reoperation rate for other indications was 3 % (95 %CI: 1 %-4%; I-2-test 10.9 %, p = 0.34). Conclusion rMUS is a highly effective and safe option for women with rSUI. Its excellent effectiveness, comparable to that of pMUS, and the lack of significant differences between RP and TO techniques underscore the flexibility and validity of this approach.