Korean J Urol.  2007 Nov;48(11):1149-1154. 10.4111/kju.2007.48.11.1149.

Comparison of Secondary Procedures for Recurrent Stress Urinary Incontinence after a Transobturator Tape Procedure: Shortening of the Tape versus Tension-free Vaginal Tape Redo

• Koh JS
• Kim HS
• Kim HW
• Lee YS
• Kim SI
• Lee KS
• Choo MS
• Lee JY

• KMID: 1997092
• DOI: http://doi.org/10.4111/kju.2007.48.11.1149

Abstract

PURPOSE: Although the reported failure rate of the transobturator tape procedure(TOT) is low, recurrence after this procedure have been reported, and no standard treatment has yet been established for the recurrence. We compared a shortening of the previously implanted tape with a repeat tension-free vaginal tape(TVT) procedure after a failed TOT procedure.
MATERIALS AND METHODS
We enrolled eighteen women(mean age: 54.38+/-9.15 years, range: 38-72) who underwent shortening of the previously implanted tape or they underwent a repeated TVT procedure due to persistent or recurrent SUI. Of the 18 women, 10 patients underwent shortening of implanted tape and the others underwent repeat TVT. All the patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary and urodynamic study that included the Valsalva leak point pressure(VLPP). The postoperative outcomes were assessed by a review of admissions and the medical charts.
RESULTS
The mean interval from first surgery to recurrence was 6.88+/-2.61 months for Monarc, 12 months for TVT-O and 4.71+/-2.42 months for T-sling. Of the 10 patients who underwent shortening of the implanted tape, 7(70%) patients were cured and the others failed. Of the 8 patients who underwent repeat TVT, 7(87.5%) patients were cured and one was significantly improved. The success rate is significantly higher in the repeated TVT group(p<0.05).
CONCLUSIONS
Both a shortening of the previously implanted tape and a repeated TVT procedure are safe, effective, viable options in the event of initial TOT sling failure. However, the success rate of the repeated TVT group is higher than that of the shortening of implanted tape group, especially for patients with an internal sphincteric deficiency. Therefore, a repeated TVT procedure is a first option in the event of initial TOT sling failure.

Keyword

Urinary Incontinence; Urethra; Tension-free vaginal tape; Transobturator tape

MeSH Terms

Female
Gynecological Examination
Humans
Recurrence
Suburethral Slings*
Urethra
Urinalysis
Urinary Incontinence*
Urodynamics

Figure

• 

  Fig. 1 Comparison of the postoperative success rate between the shortening of the implanted tape procedure and the repeat tension-free vaginal tape (TVT) procedure. The success rate of the repeat TVT group was significant higher than that of the implanted tape group (*p=0.045).

Reference

1. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996. 7:81–86.

2. Giberti C, Gallo F, Cortese P, Schenone M. Transobturator tape for treatment of female stress urinary incontinence: objective and subjective results after a mean follow-up of two years. Urology. 2007. 69:703–707.

3. Latthe P, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007. 114:522–531.

4. Seok NS, Suh HJ, Lee DH. Clinical outcome of transobturator monarc procedures for treating of women with stress urinary incontinence: the 2-year follow up. Korean J Urol. 2006. 47:835–840.

5. Park JB, Park YW, Lee J. IRIS-transobturator tape procedure for the treatment of women with stress urinary incontinence. Korean J Urol. 2006. 47:26–30.

6. Nitahara KS, Aboseif S, Tanagho EA. Long-term results of colpocystourethropexy for persistent or recurrent stress urinary incontinence. J Urol. 1999. 162:138–141.

7. Petrou SP, Frank I. Complications and initial continence rates after a repeat pubovaginal sling procedure for recurrent stress urinary incontinence. J Urol. 2001. 165:1979–1981.

8. Schulz JA, Drutz HP. The surgical management of recurrent stress urinary incontinence. Curr Opin Obstet Gynecol. 1999. 11:489–494.

9. Elliott DS, Barrett DM. The artificial urinary sphincter in the female: indications for use, surgical approach and results. Int Urogynecol J Pelvic Floor Dysfunct. 1998. 9:409–415.

10. Azam U, Frazer MI, Kozman EL, Ward K, Hilton P, Rane A. The tension-free vaginal tape procedure in women with previous failed stress incontinence surgery. J Urol. 2001. 166:554–556.

11. Riachi L, Kohli N, Miklos J. Repeat tension-free transvaginal tape (TVT) sling for the treatment of recurrent stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2002. 13:133–135.

12. Tsivian A, Neuman M, Yulish E, Shtricker A, Levin S, Cytron S, et al. Redo midurethral synthetic sling for female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2007. 18:23–26.

13. Villet R, Ercoli A, Atallah D, Hoffmann P, Salet-Lizee D. Second tension-free vaginal tape procedure and mesh retensioning: two possibilities of treatment of recurrent-persistent genuine stress urinary incontinence after a primary tension-free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2002. 13:377–379.

14. Paick JS, Ku JH, Shin JW, Park KJ, Kim SW, Oh SJ. Shortening of tension-free vaginal tape for the treatment of recurrent incontinence. J Urol. 2004. 171:1634.

15. Paick JS, Oh JG, Shin JW, Kim SW, Ku JH. Significance of tension in tension-free mid-urethral sling procedures: a preliminary study. Int Urogynecol J Pelvic Floor Dysfunct. 2007. 18:153–158.

16. Lo TS, Wang AC, Liang CC, Long CY, Lee SJ. Treatment for unsuccessful tension-free vaginal tape operation by shortening pre-implanted tape. J Urol. 2006. 175:2196–2199.

17. Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol. 2004. 45:203–207.

18. Amaye-Obu FA, Drutz HP. Surgical management of recurrent stress urinary incontinence: a 12-year experience. Am J Obstet Gynecol. 1999. 181:1296–1307.

19. Nam SB, Bae JH, Lee JG. Surgical considerations for recurrent stress urinary incontinence after the midurethral sling procedure: redo midurethral sling and shortening of the tape. Korean J Urol. 2007. 48:527–535.

20. Moore RD, Gamble K, Miklos JR. Tension-free vaginal tape sling for recurrent stress incontinence after transobturator tape sling failure. Int Urogynecol J Pelvic Floor Dysfunct. 2007. 18:309–313.