title: Tape fixation: an important surgical step to improve success rate of anti-incontinence surgery.
abstract: OBJECTIVE
  Mid urethral slings are effective surgical treatment for stress urinary incontinence. However, 5% to 20% of patients still experience surgical failure with clinically significant recurrent or persistent stress urinary incontinence. Since a subset of these failures may be caused by improper tape position, we elucidated whether additional paraurethral fixation of a tape to prevent displacement during tensioning could improve the transobturator sling outcome.
  
  
  METHODS
  The study was done in 463 patients with stress urinary incontinence who were randomly allocated to treatment with a standard transobturator intravaginal monofilament sling procedure (232) or to an intravaginal transobturator monofilament sling with additional 2-point tape fixation (231). Another 2 absorbable sutures parallel to the urethra were added to fix the tape and prevent displacement during tape tensioning. Outcome was assessed by a cough test and a 1-hour pad test at 12 months.
  
  
  RESULTS
  Clinical efficacy of the procedure with fixation was significantly higher with 195 women (95.12%) cured or improved compared to the 199 (88.73%) cured or improved with the standard sling (chi-square 5.71, p = 0.0169). There was no increase in intraoperative or postoperative complications. Also, among patients with intrinsic sphincter deficiency we noted a significantly better outcome in the fixation group than in the control group, that is 39 of 41 patients (95.1%) cured or improved vs 31 of 42 (73.8%) (chi-square 10.65, p = 0.0011).
  
  
  CONCLUSIONS
  Tape fixation significantly increases the clinical efficacy of the transobturator sling, especially in patients with intrinsic sphincter deficiency.
authors.affiliation: Second Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rechberger
authors.forename: Konrad
authors.initials: K
authors.lastname: Futyma
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Jankiewicz
authors.forename: Aneta
authors.initials: A
authors.lastname: Adamiak
authors.forename: Michał
authors.initials: M
authors.lastname: Bogusiewicz
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Bartuzi
authors.forename: Paweł
authors.initials: P
authors.lastname: Miotła
authors.forename: Paweł
authors.initials: P
authors.lastname: Skorupski
authors.forename: Jacek
authors.initials: J
authors.lastname: Tomaszewski
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D012074:Remission Induction; D053825:Suburethral Slings; D013536:Suture Techniques; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods