Effectiveness of the TVT procedure as a repeat mid-urethra operation for treatment of stress incontinence

What do we do when a midurethral tape fails? Rediscovery of open colposuspension as a salvage continence operation

“…Small retrospective studies for retropubic tapes (TVT) following a failed midurethral tape have shown subjective cure rates of 71-92% [9][10][11] and objective cure rates of 55-77% [10,12]. The general consensus is that repeat procedures carry a lower cure rate compared with the primary procedure but similar postoperative complications [11].…”

“…However, further surgical management is requested by some patients with persistent or recurrent SUI. The available surgical options are periurethral injection of bulking agents [6], shortening of the existing tape [7,8], repeat midurethral tape [9][10][11][12], adjustable slings [13], spiral slings [14], autologous fascial slings, open colposuspension, laparoscopic colposuspension [15], or placement of an artificial urinary sphincter . To date, little is known about the outcome of open colposuspension in this group of patients.…”

Management of Stress Urinary Incontinence Following a Failed Midurethral Tape

“…Small retrospective studies for retropubic tapes (tension-free vaginal tape) following a failed midurethral tape have shown subjective cure rates of 71% to 92% [17][18][19] and objective cure rates of 55% to 77% [18,20]. The insertion of the second tape does not usually require removal of the first tape.…”

Repeat midurethral sling treatment for prior midurethral sling failure

“…However, as many as 5-20% of patients experience failed sling treatment. Recently, several possible salvage options have been published, including pelvic floor rehabilitation, placement of an artificial urethral sphincter [6,7], periurethral injection of bulking agents [7], colposuspension [8,9], readjustment ( placation, shortening, or retensioning) of previously implanted tape [10][11][12][13], and a repeat MUS procedure ( TVT/TVT-O/TOT) [14][15][16][17][18][19][20][21][22]. The MUS procedure has been reported to be successful in treating recurrent/persistent SUI no matter which type of procedure had failed previously.…”

“…The etiology of persistent or recurrent SUI after surgery is unclear, but it may be related to improper adjustment of the tape intraoperatively, failure to fix the sling into place, or incorrect diagnosis of the form of incontinence [15,16,20]. Palva and Nilssion [21] grouped the reasons for a failed MUS procedure as follows: inadequate tape material, inadequate surgical technique, patient's medical condition, and unrecognized reasons. The mechanisms of the continence action of the MUS procedure (TVT/TVT-O) are the same, based on the integral theory by Ulmsten in 1993 [1].…”