Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape.

BACKGROUND

Data about the use of tension-free vaginal tape (TVT) in the management of recurrent urodynamic stress incontinence (RUSI) after previous failed midurethral sling procedure (MUSP) are limited.

OBJECTIVE

Assessment of the efficacy and the indications of the TVT procedure in the management of patients with RUSI after failed previous MUSP.

DESIGN, SETTING, AND PARTICIPANTS: Thirty-one patients with RUSI after previous failed MUSP were prospectively enrolled at a single tertiary academic center.

MEASUREMENTS

Preoperatively and postoperatively, patients were assessed with physical examination, urinalysis, urine culture, bladder diary for 2-3 d, Q-tip test, uroflow, filling and voiding cystometry, urethral profilometry, and 1-h pad test. Mean follow-up was at 18.6 mo (range: 12-28 mo).

RESULTS AND LIMITATIONS

Overall, the objective cure rate based on the pad test findings was 74%, the improvement rate was 6.5%, and the failure rate was 19.5%. The objective cure rate based on cough stress test during filling cystometry was 77.4%, and the subjective cure rate based on patients' answers was 71%. The study could have some limitations. The relatively small number of patients enrolled could affect the findings of study to some degree. Additionally, because urethral pressure profiles show a significant degree of directional dependence when side-hole microtip transducers are used, as in the present study, the orientation of the transducer could affect the values measured.

CONCLUSIONS

The TVT procedure as a second operation could provide an overall cure rate of 74% with a low complication rate in female patients with RUSI after previous failed midurethral tape procedures.