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Second tension-free tape sling for recurrent stress urinary incontinence

Author(s): Pedro Manso

Journal: Acta Obstetrica e Ginecologia Portuguesa
ISSN 1646-5830

Overview and aims: tension-free tape procedures have become widespread for the treatment of stress urinary incontinence (SUI). These techniques have evolved from retropubic to transobturator procedures and, more recently, to anchoring the tape edges into the internal obturator muscle rather than passing it through the obturator foramen. Failure of the technique can occur and this often leads to the consideration a new surgery. The aim of this study was to evaluate the success rate of a second tension-free tape procedure. Study design: retrospective, longitudinal and descriptive study.Population and methods: we reviewed the clinical files of all women operated on at our institution, between January 2001 and December 2009, for a second minimally invasive surgery due to recurrent SUI after previous tension-free tape sling procedure. Those with recurrent SUI after section of the first sling (due to exteriorization) were subsequently excluded from the analysis. Failure of surgery was assumed when SUI symptoms and urinary leakage during physical examination were present. Results: a total of 1392 tension-free tape procedures were performed at our department for SUI treatment during the study period. Success rates at first year of follow-up were 89.6% for the TVT-O procedure and 76.5% for the TOT technique. Forty-two women had a second minimally invasive surgery. Two were excluded from the analysis due to recurrent SUI after section of the first sling, leaving a study sample size of 40 patients. All were submitted to a transobturator procedure. The success rate in this group was 80% at one month after the surgical procedure and 70% at one year of follow-up (after first TVT-O:79%; after first TOT:40%). Conclusions: repeat tension-free tape sling for recurrent SUI appears to be a viable option for patients failing the initial procedure. First sling synthetic layer was not an obstacle for the new surgery.
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