Recurrent urinary stress incontinence: An overview

Aim: We review the literature regarding recurrent urinary stress incontinence (USI) following various anti-incontinence procedures and analyze possible risk factors for failure of different anti-incontinence procedures. Management options for recurrent USI and future trends are also covered. Methods: A PubMed search was undertaken for English language literature using the MeSH terms 'stress urinary incontinence', 'recurrence', 'treatment', and 'failure'. Literature from the year 2001 to 2010 was selected. We only selected those studies including randomized control trials, meta-analysis, and prospective and retrospective cohort studies for this review. Studies are analyzed on the basis of their methodical quality and time of follow-up. Results: In spite of the wide spectrum of options available, treatment of USI fails in 10-20% of patients. Management of such recurrent USI is technically challenging to the surgeon and a frustrating problem for the patient. Conclusion: TVT may be used as a high priority in patients with recurrent USI with encouraging success. For refractory USI, more advanced procedures, like periurethral bulking agents, adjustable continence therapy system, spiral sling systems remain a viable option.