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KMID : 0358320070480111149
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Korean Journal of Urology
2007 Volume.48 No. 11 p.1149 ~ p.1154
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Comparison of Secondary Procedures for Recurrent Stress Urinary Incontinence after a Transobturator Tape Procedure: Shortening of the Tape versus Tension-free Vaginal Tape Redo
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Koh Jun-Sung
Kim Hyo-Sin
Kim Hyun-Woo
Lee Yong-Seok
Kim Suk-Il
Lee Kyu-Sung
Choo Myung-Soo
Lee Ji-Youl
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Abstract
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Purpose: Although the reported failure rate of the transobturator tape procedure(TOT) is low, recurrence after this procedure have been reported, and no standard treatment has yet been established for the recurrence. We compared a shortening of the previously implanted tape with a repeat tension-free vaginal tape(TVT) procedure after a failed TOT procedure.
Materials and Methods: We enrolled eighteen women(mean age: 54.38± 9.15 years, range: 38-72) who underwent shortening of the previously implanted tape or they underwent a repeated TVT procedure due to persistent or recurrent SUI. Of the 18 women, 10 patients underwent shortening of implanted tape and the others underwent repeat TVT. All the patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary and urodynamic study that included the Valsalva leak point pressure(VLPP). The postoperative outcomes were assessed by a review of admissions and the medical charts.
Results: The mean interval from first surgery to recurrence was 6.88±2.61 months for Monarc, 12 months for TVT-O and 4.71±2.42 months for T-sling. Of the 10 patients who underwent shortening of the implanted tape, 7(70%) patients were cured and the others failed. Of the 8 patients who underwent repeat TVT, 7(87.5%) patients were cured and one was significantly improved. The success rate is significantly higher in the repeated TVT group(p＜0.05).
Conclusions: Both a shortening of the previously implanted tape and a repeated TVT procedure are safe, effective, viable options in the event of initial TOT sling failure. However, the success rate of the repeated TVT group is higher than that of the shortening of implanted tape group, especially for patients with an internal sphincteric deficiency. Therefore, a repeated TVT procedure is a first option in the event of initial TOT sling failure
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KEYWORD
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Urinary Incontinence, Urethra, Tension-free vaginal tape, Transobturator tape
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