Recurrent stress incontinence is associated with decreased neuromuscular function in the striated urethral sphincter Kimberly Kenton, MD, MS, Sangeeta Mahajan, MD, Mary Pat FitzGerald, MD, Linda Brubaker, MD, MS Division of Female Pelvic Medicine & Reconstructive Surgery, Departments of Obstetrics and Gynecology & Urology, Loyola University Medical Center, Maywood, IL Received for publication June 24, 2005; revised October 17, 2005; accepted January 13, 2006 KEY WORDS Electromyography EMG Urethral sphincter Stress incontinence Recurrent stress incontinence 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 pre- vious 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 incon- tinence surgery. Ó 2006 Mosby, Inc. All rights reserved. Previous continence surgery is associated with decreased success rates for secondary continence proce- dures. The underlying pathophysiology of the stress incontinence, 1,2 the effect of multiple surgeries and dis- sections on sphincter function, or both, may contribute to lower success rates in patients undergoing several sur- gical procedures. Previous studies have suggested that women who undergo successful continence surgery have better initial urethral sphincter neuromuscular function than women whose surgical procedure is not successful. 3,4 Presented at the Twenty-Sixth Annual Meeting of the American Urogynecologic Society, Atlanta, GA, September 15-17, 2005. Reprints not available from the authors. 0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2006.01.056 American Journal of Obstetrics and Gynecology (2006) 194, 1434–7 www.ajog.org