Skip to main content

Advertisement

SpringerLink
Log in

Sling failures: What’s next?

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

The pubovaginal sling has been used to treat anatomic, functional, and recurrent stress urinary incontinence for decades with excellent results. Nevertheless, enthusiasm for the pubovaginal sling is tempered by the surgical morbidity and postoperative voiding dysfunction associated with it. New modifications such as alternative sling materials, bone anchor suspension, and midurethral slings have been developed to reduce operating time and surgical morbidity. The less invasive approaches are now well recognized and midurethral slings have become the most common procedure performed for stress urinary incontinence. Despite the ubiquity of sling procedures in all of their forms, there is no consensus on the management of sling failures. Recent literature suggests that similar to primary genuine stress incontinence, recurrent stress urinary incontinence as a result of sling failure is being successfully managed with less invasive techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. DeLancey JO: Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 1994, 170:1713–1720.

    PubMed  CAS  Google Scholar 

  2. Petros PE, Ulmsten UI: An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol 1993, 153:1–93.

    CAS  Google Scholar 

  3. Morgan TO, Westney OL, McGuire EJ: Pubovaginal sling: 4-year outcome analysis and quality of life assessment. J Urol 2000, 163:1845–1848.

    Article  PubMed  Google Scholar 

  4. Cross CA, Cespedes RD, McGuire EJ: Our experience with pubovaginal slings in patients with stress urinary incontinence. J Urol 1998, 159:1195–1198.

    Article  PubMed  CAS  Google Scholar 

  5. Ulmsten U, Johnson P, Rezapour M: A 3-year follow-up of tension- free vaginal tape for surgical treatment of female stress urinary incontinence. Br J Obstet Gynecol 1999, 106:334–350.

    Google Scholar 

  6. Nilsson CG, Kuuva N: The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. Br J Obstet Gynecol 2001, 108:414–419.

    Article  CAS  Google Scholar 

  7. Jeffry L, Deval B, Brisan A, et al.: Objective and subjective cure rates after tension-free vaginal tape for treatment of urinary incontinence. Urology 2001, 58:702–706.

    Article  PubMed  CAS  Google Scholar 

  8. FitzGerald MP, Mollenhauer J, Brubaker L: Failure of allograft suburethral slings. BJU Int 1999, 84:785–788.

    Article  PubMed  CAS  Google Scholar 

  9. Blander DS, Zimmern PE: Cadaveric fascia lata sling: analysis of five recent adverse outcomes. Urology 2000, 56:596–599.

    Article  PubMed  CAS  Google Scholar 

  10. O’Reilly KJ, Govier FE: Intermediate term failure of pubovaginal slings using cadaveric fascia lata: a case series. J Urol 2002, 167:1356–1358.

    Article  PubMed  Google Scholar 

  11. Madjar S, Beyer M, Nativ O: Transvaginal bone anchored sling. Urology 2000, 55:422–426.

    Article  PubMed  CAS  Google Scholar 

  12. Schostak M, Miller K, Muller M, et al.: Transvaginal bone anchors in female stress urinary incontinence: poor results. Gynecol Obstet Invest 2002, 54:154–158.

    Article  PubMed  CAS  Google Scholar 

  13. Carbone JM, Kavaler E, Hu J, et al.: Pubovaginal sling using cadaveric fascia and bone anchors: disappointing early results. J Urol 2001, 165:1605–1611.

    Article  PubMed  CAS  Google Scholar 

  14. Kane L, Chung H, Iskaros LJ: The pubofascial anchor sling procedure for recurrent genuine stress incontinence. BJU Int 1999, 83:1010–1014.

    Article  PubMed  CAS  Google Scholar 

  15. Monga AK, Robinson D, Stanton SL: Periurethral collagen injections for genuine stress incontinence: a 2-year followup. Br J Urol 1995, 76:156–160.

    Article  PubMed  CAS  Google Scholar 

  16. Corcos J, Fournier C: Periurethral collagen injection for the treatment of female stress urinary incontinence: 4-year follow-up results. Urology 1999, 54:815–818.

    Article  PubMed  CAS  Google Scholar 

  17. Appell R: Injectables for urethral incompetence. World J Urol 1990, 8:208–211.

    Article  Google Scholar 

  18. Swami S, Batista JE, Abrams P: Collagen for female genuine stress incontinence after minimum 2-year follow-up. Br J Urol 1997, 80:757–761.

    PubMed  CAS  Google Scholar 

  19. Homma Y, Kawabe K, Kageyama S, et al.: Injection of glutaraldehyde cross-linked collagen for urinary incontinence: two year efficacy by self-assessment. Int J Urol 1996, 3:124–127.

    PubMed  CAS  Google Scholar 

  20. Richardson TD, Kennelly MJ, Faerber GJ: Endoscopic injection of glutaraldehyde cross-linked collagen for the treatment of intrinsic sphincter deficiency in women. Urology 1995, 46:378–381.

    Article  PubMed  CAS  Google Scholar 

  21. Lightner D, Calvosa C, Anderson R, et al.: A new injectable bulking agent for treatment of stress urinary incontinence: results of a multicenter, randomized, controlled, doubleblind study of Durasphere. Urology 2001, 58:12–15.

    Article  PubMed  CAS  Google Scholar 

  22. Chrouser KL, Fick F, Goel A, et al.: Carbon coated zirconium beads in _-glucan gel and bovine glutaraldehyde crosslinked collagen injections for intrinsic sphincteric deficiency: continence and satisfaction after extended follow-up. J Urol 2004, 171:1152–1155.

    Article  PubMed  CAS  Google Scholar 

  23. Haab F, Zimmern PE, Leach GE: Urinary stress incontinence due to intrinsic sphincteric deficiency: experience with fat and collagen periurethral injections. J Urol 1997, 157:1283–1286.

    Article  PubMed  CAS  Google Scholar 

  24. Stothers L, Goldenberg SL, Leone EF: Complications of periurethral collagen injection for stress urinary incontinence. J Urol 1998, 159:806–807.

    Article  PubMed  CAS  Google Scholar 

  25. Maher CF, Dwyer PL, Carey MP, et al.: Colposuspension or sling for low urethral pressure stress incontinence?. Int Urogynecol J 1999, 10:384–389.

    Article  CAS  Google Scholar 

  26. Amaye-Obe FA, Drutz HP: Surgical management of recurrent stress urinary incontinence: a 12-year experience. Am J Obstet Gynecol 1999, 181:1296–1307.

    Article  Google Scholar 

  27. Chaikin DC, Rosenthal J, Blaivas JG: Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol 1998, 160:1312–1316.

    Article  PubMed  CAS  Google Scholar 

  28. Blaivas JG, Jacobs BZ: Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J Urol 1991, 145:1214–1218.

    PubMed  CAS  Google Scholar 

  29. Breen JM, Geer BE, May GE: The fascia lata suburethral sling for treating recurrent urinary stress incontinence. Am J Obstet Gynecol 1997, 177:1363–1366.

    Article  PubMed  CAS  Google Scholar 

  30. Groutz A, Blaivas JG, Hyman MJ, et al.: Pubovaginal sling surgery for simple stress urinary incontinence: analysis by an outcome score. J Urol 2001, 165:1597–1600.

    Article  PubMed  CAS  Google Scholar 

  31. Petrou SP, Frank I: Complications and initial continence rates after a repeat pubovaginal sling procedure for recurrent stress urinary incontinence. J Urol 2001, 165:1979–1981. A small study (n = 14), but points out that a repeat sling is associated with a low complication rate; however, this is a harder group to treat. Success rates were only 50%.

    Article  PubMed  CAS  Google Scholar 

  32. Choe JM: Suprapubic sling adjustment: minimally invasive method of curing recurrent stress incontinence after sling surgery. J Urol 2002, 168:2059–2062. The reader should be aware that the slings adjusted in this manner were patch slings that do not enter the retropubic space. Adjusting sling tension in this manner would likely not be successful with a long fascial sling.

    Article  PubMed  Google Scholar 

  33. McGuire EJ: Editorial: sling procedure for incontinence. J Urol 2002, 168:2069–2070.

    Article  PubMed  Google Scholar 

  34. Nilsson GG, Kuuva N, Falconer C, et al.: Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2001, 12(suppl 2):S5-S8.

    Article  PubMed  Google Scholar 

  35. Rezapour M, Ulmsten U: Tension-free vaginal tape (TVT) in women with mixed urinary incontinence: a long-term follow-up. Int Urogynecol J 2001, 12(suppl 2):S15-S18.

    Article  Google Scholar 

  36. Rezapour M, Falconer C, Ulmsten U: Tension-free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD): a long-term follow-up. Int Urogynecol J 2001, 12(suppl 2):S12-S14. Although TVT is feasible in patients with low leak-point pressures, the cure rate is markedly lower (70%) in this population. Any surgeon using midurethral polypropylene slings should be aware of poorer outcomes in ISD.

    Article  Google Scholar 

  37. Rezapour M, Ulmsten U: tension-free vaginal tape (TVT) in women with recurrent stress urinary incontinence: a longterm follow-up. Int Urogynecol J 2001, 12(suppl 2):S9-S11. This article provides intermediate-term follow-up of TVT after other failed anti-incontinence surgery. Although success was good (82%), it is important to understand the patient population. None of these patients had ISD or a fixed urethra.

    Article  Google Scholar 

  38. Rardin CR, Kohli N, Rosenblatt PL, et al.: Tension-free vaginal tape: outcomes among women with primary versus recurrent stress urinary incontinence. Obstet Gynecol 2002, 100:893–897.

    Article  PubMed  CAS  Google Scholar 

  39. Azam U, Frazier M, Kozman EL, et al.: The Tension-free vaginal tape procedure in women with previous failed stress incontinence surgery. J Urol 2001, 166:554–556. A prospective multicenter study of 67 patients with 1-year follow-up. Results point out that TVT after a prior failed anti-incontinence surgery may be complicated by a higher rate of bladder perforation and surgical failure.

    Article  PubMed  CAS  Google Scholar 

  40. Kuuva N, Nilsson CG: Tension-free vaginal tape procedure: an effective minimally invasive operation for the treatment of recurrent stress urinary incontinence. Gynecol Obstet Invest 2003, 56:93–98. This prospective study of 51 patients with a minimum of 2-year follow-up is strengthened by preoperative and postoperative urodynamic evaluations. However, it is limited by the lack of description of failures. Were all of the failures in women with fixed urethras or ISD as other studies suggest?

    Article  PubMed  Google Scholar 

  41. Lo TS, Horng SG, Chang CL, et al.: Tension-free vaginal tape procedure after previous failure in incontinence surgery. Urology 2002, 60:57–61.

    Article  PubMed  Google Scholar 

  42. Riachi L, Kohli N, Miklos J: Repeat tension-free transvaginal tape (TVT) sling for the treatment of recurrent stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2002, 13:133–135. This intriguing initial case report of a repeat TVT after a failed TVT gives support to the idea that it can be done. In these two cases, the original tape was left undisturbed and both women became dry. Both patients also had urethral hypermobility of 30 degrees or more, which is important in assuring success of midurethral slings whether in primary or recurrent SUI.

    Article  PubMed  CAS  Google Scholar 

  43. Villet R, Ercoli A, Atallah D, et al.: Second tension-free vaginal tape procedure and mesh retensioning: two possibilities of treatment of recurrent-persistent genuine stress urinary incontinence after a primary tension-free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct 2002, 13:377–379.

    Article  PubMed  CAS  Google Scholar 

  44. Neuman M: Transvaginal tape readjustment after unsuccessful tension-free vaginal tape operation. Neurol Urodyn 2004, 23:282–283.

    Article  Google Scholar 

  45. deTayrac R, Deffieux X, Droupy S, et al.: A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 2004, 190:602–608.

    Article  PubMed  Google Scholar 

  46. Nitti VW: Advancements in assessments and management of female stress urinary incontinence. Presented at the American Urological Association 99th Annual Meeting. San Francisco: May 8–13, 2004.

Download references

Author information

Authors and Affiliations

  1. Department of Urologic Surgery, Vanderbilt University, A-1302 Medical Center North, 37232, Nashville, TN, USA

    Harriette M. Scarpero MD

Authors
  1. Harriette M. Scarpero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roger R. Dmochowski MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scarpero, H.M., Dmochowski, R.R. Sling failures: What’s next?. Curr Urol Rep 5, 389–396 (2004). https://doi.org/10.1007/s11934-004-0089-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-004-0089-4

Keywords

Search

Navigation