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. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.