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Koh, Kim, Kim, Lee, Kim, Lee, Choo, and Lee: Comparison of Secondary Procedures for Recurrent Stress Urinary Incontinence after a Transobturator Tape Procedure: Shortening of the Tape versus Tension-free Vaginal Tape Redo
Original Article
Korean Journal of Urology

Korean Journal of Urology 2007; 48(11): 1149-1154.

Published online: 30 November 2007

DOI: https://doi.org/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

Jun Sung Koh, Hyo Sin Kim, Hyun Woo Kim, Yong Seok Lee, Suk Il Kim1, Kyu Sung Lee2, Myung Soo Choo3, Ji Youl Lee

Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea.

1Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

2Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea.

3Department of Urology, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author (uroljy@catholic.ac.kr)

Received 21 August 2007       Accepted 5 October 2007

Copyright © 2007 The Korean Urological Association

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.

Keywords: Urinary Incontinence, Urethra, Tension-free vaginal tape, Transobturator tape

Figures and Tables

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).
kju-48-1149-g001
Table 1
Patient characteristics and urodynamic findings before surgery, and the results of second surgery
kju-48-1149-i001

M: Monarc, O: tension free vaginal tape obturator, T: T-sling, SUI: stress urinary incontinence, TVT: tension-free vaginal tape, S: shortening of implanted tape, VLPP: Valsalva leak point pressure

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