Introduction and hypothesis
Management of stress urinary incontinence (SUI) after a transobturator tape (TOT) failure is a controversial issue. There are few long-term data on the different treatment options. The aim of this study is to evaluate the long-term effectiveness and safety of retropubic suburethral slings (RP-TVT) in this setting.
A descriptive retrospective study was performed among women with persistent/recurrent SUI treated at the Vall d’Hebron University Hospital between January 2006 and December 2014. All women were preoperatively evaluated to rule out complications of the first sling. Postoperative follow-up was performed at 1, 6 and 12 months and yearly thereafter. Outcomes were classified as cured, improved or failed.
Forty-one women were operated on over the study period. The median follow-up time was 103.2 months. Likelihood to be cured or improved at 3, 5, 7 and 10 years was 78.0%, 75.4%, 71.9% and 67.4%, respectively. Absence of urethral hypermobility was the only variable related to RP-TVT failure. Complications during follow-up were observed in 39% of patients, although most of them were mild. However, two cases (4.9%) of vaginal exposure and three (7.3%) of lower urinary tract extrusion were observed. De novo urgency occurred 17.1% of women.
RP-TVT showed reasonable long-term effectiveness but had a high overall complication rate in the treatment of persistent/recurrent SUI after TOT. Expected outcomes and possible side effects should be discussed in detail during counseling before opting for a treatment option.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD006375. https://doi.org/10.1002/14651858.CD006375.pub4.
Karmakar D, Mostafa A, Abdel-Fattah M. Long-term outcomes of transobturator tapes in women with stress urinary incontinence: E-TOT randomised controlled trial. BJOG. 2017;124:973–81. https://doi.org/10.1111/1471-0528.14561.
Zimmern PE, Gormley EA, Stoddard AM, et al. Management of recurrent stress urinary incontinence after burch and sling procedures. Neurourol Urodyn. 2016;35:344–8. https://doi.org/10.1002/nau.22714.
Tincello DG, Armstrong N, Hilton P, et al. Surgery for recurrent stress urinary incontinence: the views of surgeons and women. Int Urogynecol J. 2018;29:45–54. https://doi.org/10.1007/s00192-017-3376-6.
Giarenis I, Thiagamoorthy G, Zacchè M, et al. Management of recurrent stress urinary incontinence after failed midurethral sling: a survey of members of the International Urogynecological Association (IUGA). Int Urogynecol J. 2015;26:1285–91. https://doi.org/10.1007/s00192-015-2696-7.
Bakali E, Buckley BS, Hilton P, Tincello DG. Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women. Cochrane Database Syst Rev. 2013;CD009407. https://doi.org/10.1002/14651858.CD009407.pub2.
Nikolopoulos KI, Betschart C, Doumouchtsis SK. The surgical management of recurrent stress urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2015;94:568–76. https://doi.org/10.1111/aogs.12625.
Haylen BT, Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26. https://doi.org/10.1007/s00192-009-0976-9.
Liapis A, Bakas P, Creatsas G. Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Eur Urol. 2009;55:1450–5. https://doi.org/10.1016/j.eururo.2009.03.025.
Meyer F, Hermieu JF, Boyd A, et al. Repeat mid-urethral sling for recurrent female stress urinary incontinence. Int Urogynecol J. 2013;24:817–22. https://doi.org/10.1007/s00192-012-1941-6.
Simsek A, Ozgor F, Kirecci SL, et al. Results of tension-free vaginal tape for recurrent stress urinary incontinence after unsuccessful transobturator tape surgery. J Obstet Gynaecol Res. 2014;40:1764–9. https://doi.org/10.1111/jog.12410.
Sabadell J, Poza JL, Esgueva A, et al. Usefulness of retropubic tape for recurrent stress incontinence after transobturator tape failure. Int Urogynecol J. 2011;22:1543–7. https://doi.org/10.1007/s00192-011-1490-4.
Verbrugghe A, De Ridder D, Van der Aa F. A repeat mid-urethral sling as valuable treatment for persistent or recurrent stress urinary incontinence. Int Urogynecol J. 2013;24:999–1004. https://doi.org/10.1007/s00192-012-1971-0.
Neuman M. The TVT procedure as second-line anti-incontinence surgery for TVT-obturator failure patients. J Pelvic Med Surg. 2006;12:161–3.
Minassian VA, Yan X, Pilzek AL, et al. Does transition of urinary incontinence from one subtype to another represent progression of the disease? Int Urogynecol J. 2018;29:1179–85. https://doi.org/10.1007/s00192-018-3596-4.
Lo T-S, Pue LB, Tan YL, Wu P-Y. Risk factors for failure of repeat midurethral sling surgery for recurrent or persistent stress urinary incontinence. Int Urogynecol J. 2016;27:923–31. https://doi.org/10.1007/s00192-015-2912-5.
Smithling KR, Adams-Piper EE, Tran AAM, et al. Efficacy of repeat Midurethral sling for persistent or recurrent stress urinary incontinence: A Fellows Pelvic Research Network Study. Female Pelvic Med Reconstr Surg. 2018. https://doi.org/10.1097/SPV.0000000000000598.
Steele SE, Hill AJ, Unger CA. Concurrent midurethral sling excision or lysis at the time of repeat sling for treatment of recurrent or persistent stress urinary incontinence. Int Urogynecol J. 2018;29:285–90. https://doi.org/10.1007/s00192-017-3385-5.
Pradhan A, Jain P, Latthe PM. Effectiveness of midurethral slings in recurrent stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2012;23:831–41. https://doi.org/10.1007/s00192-012-1803-2.
van der Doelen MJ, Withagen MIJ, Vierhout ME, Heesakkers JPFA. Results of primary versus recurrent surgery to treat stress urinary incontinence in women. Int Urogynecol J. 2015;26:997–1005. https://doi.org/10.1007/s00192-015-2627-7.
Conflicts of interest
JL Poza has received a speaker honorarium from Astellas Pharma outside the submitted work.
The remaining authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Sabadell, J., Montero-Armengol, A., Rodríguez-Mias, N. et al. Long-term outcomes of retropubic tension-free vaginal tape for stress urinary incontinence after a transobturator tape failure: a retrospective study. Int Urogynecol J 31, 755–760 (2020). https://doi.org/10.1007/s00192-019-04169-4
- Stress urinary incontinence
- Retropubic tape
- Midurethral sling
- Tension-free vaginal tape