title: [Tethered tape or the fourth factor. A new cause of recurrent stress incontinence after midurethral tape procedures vaginal tape insertion].
abstract: BACKGROUND
  This is the first report of a newly identified cause of recurrent stress urinary incontinence (SUI) after midurethral tape insertion.
  
  
  METHODS
  This article reports a series of cases with primary or secondary tape failure including clinical presentation and findings, the results of pelvic floor (PF) ultrasound, and the (surgical) correction of malpositioned vaginal tapes.
  
  
  RESULTS
  A vaginal tape for treating SUI must be accurately placed under the mid-third of the urethra and at a distance of 3-5 mm from the urethra. Alignment parallel to the urethra in the urethrovaginal septum is also essential for adequate function. A tethered tape refers to the adhesion of a tape edge to the anterior vaginal wall either during primary wound closure or due to secondary ingrowths and is typically associated with recurrent SUI during activities or changes in posture. Less common is SUI through an increase in pressure from cranially, which occurs when coughing or laughing. "Vaginal polyps" may point to imminent vaginal erosion of the tape. In the sagittal plane, the PF examination will identify an oblique orientation of the tape at rest, an abnormal closeness of the tape to the transducer, and changes in tape shape upon manipulation of the vaginal probe. Once the diagnosis has been established, a tethered tape is easy to correct by realignment or tightening to accomplish correct positioning parallel to the urethra. This measure restores tape function and continence.
  
  
  CONCLUSIONS
  Primary or secondary failure of a tension-free vaginal tape may be caused by a tethered tape. This complication can be diagnosed on the basis of characteristic findings at PF ultrasound. In most women, the tape position can be corrected and there is no need for tape removal.
authors.affiliation: Abteilung für Gynäkologie und Geburtshilfe, Ev. Krankenhaus Hagen-Haspe gGmbH, Urogynäkologisches Ausbildungszentrum AGUB III, Kontinenz- und Beckenbodenzentrum Hagen-Witten, Brusebrinkstraße 20, 58135, Hagen-Haspe, Deutschland, kociszewski@evk-haspe.de.
authors.forename: J
authors.initials: J
authors.lastname: Kociszewski
authors.forename: G
authors.initials: G
authors.lastname: Fabian
authors.forename: S
authors.initials: S
authors.lastname: Grothey
authors.forename: V
authors.initials: V
authors.lastname: Viereck
authors.forename: I
authors.initials: I
authors.lastname: Füsgen
authors.forename: A
authors.initials: A
authors.lastname: Wiedemann
mesh_terms: D000328:Adult; D020878:Device Removal / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D055502:Secondary Prevention; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*
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