title: Treatment for unsuccessful tension-free vaginal tape operation by shortening pre-implanted tape.
abstract: OBJECTIVE
  We studied the efficacy of shortening the pre-implanted suburethral tape in patients with recurrent urodynamic stress incontinence after a TVT operation.
  
  
  METHODS
  A total of 14 women, including 6 with ISD, were treated for recurrent urodynamic stress incontinence after the initial TVT operation by performing the shortening procedure under local anesthesia. Urodynamics, a 1-hour pad test, introital ultrasonography of the urethra and a cotton swab test were done before the procedure and 1 year postoperatively.
  
  
  RESULTS
  All 14 patients completed the shortening procedure. Mean patient age was 47.2 years (range 43 to 66). Mean time between initial TVT and the shortening procedure was 4 months (range 3 to 14). Ten patients (71.4%) were objectively cured and treatment failed in 4 (2 with ISD and 2 with a fixed urethra). Mean operative time was 17 minutes (range 10 to 25). No intraoperative surgical complications were observed. The 1-hour pad test showed a decrease from a median of 9.0 gm to 1.0. Median postoperative hospital stay was 1 day (range 1 to 4). Spontaneous voiding with adequate post-void residual urine was noted in all patients before discharge home.
  
  
  CONCLUSIONS
  Shortening a pre-implanted TVT tape for the treatment of recurrent urodynamic stress incontinence is a safe, effective and minimally invasive option requiring only a short hospital stay. However, ISD and an immobile urethra seem to be risk factors for failure. Long-term followup is needed to determine if this surgery achieves long-lasting results.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan, Republic of China.
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Alex C
authors.initials: AC
authors.lastname: Wang
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Long
authors.forename: Shu-Jane
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D019233:Retreatment; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014621:Vagina