Recurrent stress incontinence is associated with decreased neuromuscular function in the striated urethral sphincter

Objective: The study aim was to compare urethral neuromuscular function in stress incontinent women with and without previous incontinence surgery. Study design: Urethral electromyographic (EMG) data for women with recurrent urodynamic stress incontinence following 1 previous continence procedure were compared to age- and parity-matched women with urodynamic stress incontinence (USI) without previous incontinence surgery. The cases with recurrent USI included 13 women with 1 previous sling and 13 women with 1 previous Burch. EMG signals were obtained at rest, with cough, and during pelvic floor contraction using an automated software program. EMG data from recurrent cases were compared with controls. Results: Women with recurrent stress incontinence after 1 previous continence procedure had lower quantitative EMG values than women without previous surgery. Specifically, we observed that women with previous sling had significantly lower quantitative EMG values with cough (P = .007), while baseline and squeeze values were not significantly different. Women with previous Burch had cough EMG values intermediate between the control and previous sling group, which trended toward statistical significance (P = .057). Conclusion: Women with recurrent urodynamic stress incontinence after previous slings have poorer urethral neuromuscular function than stress incontinent women without previous incontinence surgery.