Repeat transobturator tape after failed mid-urethral sling procedure: follow-up with questionnaire-based assessment.
OBJECTIVE
To determine if repeat transobturator tape (TOT) is feasible after failed initial synthetic mid-urethral sling (MUS) for stress urinary incontinence, and to ascertain objective physician-determined outcome as well as subjective questionnaire-based outcome for this procedure.


METHODS
Between February 2005 and February 2008, a total of 21 patients underwent repeat TOT procedure after failed sling treatment. Initial sling procedures were all synthetic MUS, i.e. tension-free vaginal tape in 5 cases and TOT in 16 cases.


RESULTS
At a mean follow-up of 16 months, physician-determined cure was achieved in 55% of patients, improvement in 15% and failure in 30%. Outcome deduced from the International Consultation on Incontinence Questionnaire at a mean follow-up of 17 months showed 53% of patients to be cured and 5% of patients to be improved, but failure was noted in 42% of patients.


CONCLUSIONS
Repeat TOT after failed synthetic MUS treatment is a feasible procedure with minor morbidity. Repeat TOT provides a reasonable physician-determined success rate, but a lower patient self-reported success rate can be deduced from questionnaires. The transobturator approach seems to show poorer outcomes than the retropubic approach in repeat sling surgery.
Van Baelen
Anthony A A
AA
Department of Urology, Atrium Medical Centre, Heerlen, The Netherlands. anthonyvanbaelen@hotmail.com
Delaere
Karl P J
KP
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery*