title: Operative shortening of the sling as a second-line treatment after TVT failure.
abstract: BACKGROUND
  Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure.
  
  
  METHODS
  Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients.
  
  
  RESULTS
  All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure.
  
  
  CONCLUSIONS
  The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure.
authors.affiliation: Department of Urology Medical University of Gdańsk, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Gibas
authors.affiliation: Department of Urology Medical University of Gdańsk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Matuszewski
authors.affiliation: Department of Urology Medical University of Gdańsk, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Michajłowski
authors.affiliation: Department of Urology Medical University of Gdańsk, Poland.
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Krajka
keywords: TVT failure; female; midurethral sling; stress urinary incontinence