International Urogynecology Journal

, Volume 24, Issue 10, pp 1639–1644

A prospective study of transobturator tape as treatment for stress urinary incontinence after transvaginal mesh repair

  • Hui-Hsuan Lau
  • Tsung-Hsien Su
  • Wen-Chu Huang
  • Ching-Hung Hsieh
  • Chin-Hui Su
  • Rhu-Chu Chang
Original Article


Introduction and hypothesis

The transobturator suburethral sling is a common surgical treatment for stress urinary incontinence (SUI). In patients with incontinence after trocar-guided transvaginal mesh repair (Prolift™), data on outcome remain limited. In the present study, we hypothesized that transobturator tape in such cases is assumed to be as effective as surgery alone.


This was a prospective analysis of outcomes of transobturator slings in women who had undergone transvaginal mesh repair and in those who underwent sling surgery alone (controls). Objective cure was defined as the absence of urinary leakage during the stress test at filling cystometry and a negative cough test during pelvic examination. The success rates were evaluated 3–6 months postoperatively.


One hundred women were recruited for the study. Compared to the control group, women after transvaginal mesh repair had a significantly lower objective success rate (62 vs 86 %, p = 0.005) and poorer bladder neck mobility (0.5 ± 0.8 vs 1.1 ± 0.5 cm, p = 0.001).


The transobturator sling has lower objective success rate in women after transvaginal mesh that may be due to decreased bladder neck mobility. Patients with post-mesh repair SUI who opt for sling surgery should be informed of these less satisfactory outcomes during preoperative counseling.


Anti-incontinence surgery Pelvic organ prolapse Transobturator suburethral tape Urinary incontinence 



Stress urinary incontinence


  1. 1.
    Simon M, Debodinance P (2011) Vaginal prolapse repair using the Prolift kit: a registry of 100 successive cases. Eur J Obstet Gynecol Reprod Biol 158:104–109PubMedCrossRefGoogle Scholar
  2. 2.
    Huang WC, Lin TY, Lau HH, Chen SS, Hsieh CH, Su TH (2011) Outcome of transvaginal pelvic reconstructive surgery with Prolift after a median of 2 years’ follow-up. Int Urogynecol J 22:197–203PubMedCrossRefGoogle Scholar
  3. 3.
    Su TH, Liu PE, Lau HH, Huang WC, Lin TY, Hsieh CH (2011) Impact of Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse. Int Urogynecol J 22:585–590PubMedCrossRefGoogle Scholar
  4. 4.
    Ek M, Altman D, Falconer C, Kulseng-Hanssen S, Tegerstedt G (2010) Effects of anterior trocar guided transvaginal mesh surgery on lower urinary tract symptoms. Neurourol Urodyn 29:1419–1423PubMedCrossRefGoogle Scholar
  5. 5.
    Liang CC, Lin YH, Chang YL, Chang SD (2011) Urodynamic and clinical effects of transvaginal mesh repair for severe cystocele with and without urinary incontinence. Int J Gynaecol Obstet 112:182–186PubMedCrossRefGoogle Scholar
  6. 6.
    Ek M, Tegerstedt G, Falconer C et al (2010) Urodynamic assessment of anterior vaginal wall surgery: a randomized comparison between colporrhaphy and transvaginal mesh. Neurourol Urodyn 29:527–531PubMedCrossRefGoogle Scholar
  7. 7.
    Brubaker L, Cundiff GW, Fine P et al (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354:1557–1566PubMedCrossRefGoogle Scholar
  8. 8.
    Wei JT, Nygaard I, Richter HE et al (2012) A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 366:2358–2367PubMedCrossRefGoogle Scholar
  9. 9.
    Domingo S, Alamá P, Ruiz N et al (2007) Transobturator tape procedure outcome: a clinical and quality of life analysis of a 1-year follow-up. Int Urogynecol J Pelvic Floor Dysfunct 18:895–900PubMedCrossRefGoogle Scholar
  10. 10.
    Waltregny D, Gaspar Y, Reul O et al (2008) TVT-O for the treatment of female stress urinary incontinence: results of a prospective study after a 3-year minimum follow-up. Eur Urol 53:401–408PubMedCrossRefGoogle Scholar
  11. 11.
    Uebersax JS, Wyman JF, Shumaker SA et al (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 14:131–139PubMedCrossRefGoogle Scholar
  12. 12.
    Hodgkinson CP, Doub H, Keely W (1958) Urethrocystograms. Obstet Gynecol 1:1668Google Scholar
  13. 13.
    Haylen B, de Ridder D, Freeman R et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26PubMedCrossRefGoogle Scholar
  14. 14.
    Barber MD, Kleeman S, Karram MM et al (2008) Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings. Am J Obstet Gynecol 199:666.e1–666.e7CrossRefGoogle Scholar
  15. 15.
    Abdel-Fattah M, Familusi A, Ramsay I, Ayansina D, Mostafa A (2010) Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence. Int J Gynaecol Obstet 110:18–22PubMedCrossRefGoogle Scholar
  16. 16.
    Sergent F, Gay-Crosier G, Bisson V, Resch B, Verspyck E, Marpeau L (2009) Ineffectiveness of associating a suburethral tape to a transobturator mesh for cystocele correction on concomitant stress urinary incontinence. Urology 74:765–770PubMedCrossRefGoogle Scholar
  17. 17.
    Sergent F, Sentilhes L, Resch B et al (2010) Treatment of concomitant prolapse and stress urinary incontinence via a transobturator subvesical mesh without independent suburethral tape. Acta Obstet Gynecol Scand 89:223–229PubMedCrossRefGoogle Scholar
  18. 18.
    Kuo HC (2001) Anatomical and functional results of pubovaginal sling procedure using polypropylene mesh for the treatment of stress urinary incontinence. J Urol 166:152–157PubMedCrossRefGoogle Scholar
  19. 19.
    Sarlos D, Kuronen M, Schaer GN (2003) How does tension-free vaginal tape correct stress incontinence? Investigation by perineal ultrasound. Int Urogynecol J Pelvic Floor Dysfunct 14:395–398PubMedCrossRefGoogle Scholar
  20. 20.
    Foulot H, Uzan I, Chopin N, Borghese B, Chapron C (2007) Monarc transobturator sling system for the treatment of female urinary stress incontinence: results of a post-operative transvaginal ultrasonography. Int Urogynecol J Pelvic Floor Dysfunct 18:857–861PubMedCrossRefGoogle Scholar
  21. 21.
    Law YM, Fielding JR (2008) MRI of pelvic floor dysfunction: review. AJR Am J Roentgenol 191:S45–S53PubMedCrossRefGoogle Scholar
  22. 22.
    Viereck V, Pauer HU, Hesse O et al (2006) Urethral hypermobility after anti-incontinence surgery—a prognostic indicator? Int Urogynecol J Pelvic Floor Dysfunct 17:586–592PubMedCrossRefGoogle Scholar
  23. 23.
    Fritel X, Zabak K, Pigne A, Demaria F, Benifla JL (2002) Predictive value of urethral mobility before suburethral tape procedure for urinary stress incontinence in women. J Urol 168:2472–2475PubMedCrossRefGoogle Scholar
  24. 24.
    Sabadell J, Poza JL, Esgueva A, Morales JC, Sánchez-Iglesias JL, Xercavins J (2011) Usefulness of retropubic tape for recurrent stress incontinence after transobturator tape failure. Int Urogynecol J 22:1543–1547PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Hui-Hsuan Lau
    • 1
    • 2
  • Tsung-Hsien Su
    • 1
    • 2
    • 3
  • Wen-Chu Huang
    • 1
    • 2
  • Ching-Hung Hsieh
    • 4
  • Chin-Hui Su
    • 2
    • 5
  • Rhu-Chu Chang
    • 2
  1. 1.Department of Obstetrics and Gynecology, Division of Urogynecology, Department of Obstetrics and GynecologyMackay Memorial HospitalTaipeiTaiwan
  2. 2.Mackay MedicineNursing and Management CollegeTaipeiTaiwan
  3. 3.Taipei Medical UniversityTaipeiTaiwan
  4. 4.Department of Obstetrics and GynecologyClinic of Fu Jen Catholic UniversityTaipeiTaiwan
  5. 5.Department of OtorhinolaryngologyMackay Memorial HospitalTaipeiTaiwan

Personalised recommendations