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Abstract
Purpose
There are no clear-cut guidelines of how to treat patients who have failed after a tension-free midurethral sling (MUS) procedure. We describe our experience with repeat MUS procedures and transvaginal shortening of the previously implanted tape for those patients with an initially failed MUS procedure.
Materials and Methods
We reviewed the medical records of the patients who failed with their initial MUS procedure and then had a second operation. Of the 20 women, 14 patients had repeat MUS and another 6 patients underwent shortening of the implanted tape. Repeated MUS was done by either the retropubic or transobturator pathway. Shortening of the tape was done with a metal hemoclip to shorten the previously implanted tape. The preoperative characteristics and the intraoperative and postoperative data were assessed by reviewing the operative notes, medical records and office notes.
Results
The mean interval between the first and repeat procedures was 8.4 months (range: 1-48). The mean follow up time after the second operation was 29.9 months (range: 7-70). Seven patients underwent repeat MUS instead of tape shortening because the implanted tape had migrated or severe adhesions were noted on the intraoperative findings. Ten (71.4%) of 14 patients who underwent repeat MUS achieved full continence, while 4 patients (28.6%) had significant improvement. Of the patients with tape shortening, 4 (66.6%) achieved full continence, one (16.7%) improved and one (16.7%) was failed.
Figures and Tables
Table 3
Intraoperative findings and results of the second operation
*: interval between first procedure and second procedure, †: Burch colposuspension and tension-free vaginal tape, ‡: patient number 7 and 15 are the same patient. In this case, incontinence recurred at 9 months after tape shortening with clip interposition, §: partial cystectomy was done simultaneously with second midurethral sling procedure. TVT: tension-free vaginal tape, TVTO: tension-free vaginal tape obturator, TOT: transobturator tape, MUS: midurethral sling
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