Long-term outcomes of retropubic tension-free vaginal tape for stress urinary incontinence after a transobturator tape failure: a retrospective study

A Commentary to this article was published on 11 December 2019


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.

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  1. 1.

    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.

    Article  PubMed  Google Scholar 

  2. 2.

    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.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    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.

    Article  PubMed  Google Scholar 

  4. 4.

    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.

    Article  PubMed  Google Scholar 

  5. 5.

    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.

    Article  PubMed  Google Scholar 

  6. 6.

    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.

  7. 7.

    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.

    Article  PubMed  Google Scholar 

  8. 8.

    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.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 10.

    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.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    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.

    Article  PubMed  Google Scholar 

  12. 12.

    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.

    Article  PubMed  Google Scholar 

  13. 13.

    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.

    Article  PubMed  Google Scholar 

  14. 14.

    Neuman M. The TVT procedure as second-line anti-incontinence surgery for TVT-obturator failure patients. J Pelvic Med Surg. 2006;12:161–3.

    Article  Google Scholar 

  15. 15.

    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.

    Article  PubMed  Google Scholar 

  16. 16.

    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.

    Article  PubMed  Google Scholar 

  17. 17.

    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.

  18. 18.

    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.

    Article  PubMed  Google Scholar 

  19. 19.

    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.

    Article  PubMed  Google Scholar 

  20. 20.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Jordi Sabadell.

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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.

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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

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  • Failure
  • Recurrent
  • Stress urinary incontinence
  • Retropubic tape
  • Midurethral sling
  • Tension-free vaginal tape