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NEUROUROLOGY
& FEMALE UROLOGY
Treatment
for Unsuccessful Tension-Free Vaginal Tape Operation by Shortening Pre-Implanted
Tape
Lo TS, Wang AC, Liang CC, Long CY, Lee SJ
Division of Urogynecology, Department of Obstetrics and Gynecology, Chang
Gung Memorial Hospital, Linkou Medical Center, Taiwan, Republic of China
J Urol. 2006; 175: 2196-9; discussion 2199-200
- Purpose:
We studied the efficacy of shortening the pre-implanted suburethral
tape in patients with recurrent urodynamic stress incontinence after
a TVT operation.
-
Materials And 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.
- Editorial
Comment
The authors describe a method to address recurrent urinary incontinence
after failed TVT by transvaginal plication of the in situ TVT tape.
The authors managed to objectively cure 10 out of the 14 patients (71.4%)
with this maneuver while 4 continued with recurrent stress incontinence.
Addressing of recurrent urinary incontinence after TVT has been a topic
of discussion in the literature. The above method as described appears
to be quite technically facile with a very reasonable salvage success
rate. The authors, while performing the transvaginal procedure, did
not have any difficulty in locating the in situ sling. Secondary to
the actual nature of the TVT procedure, the in place tightening of sutures
cannot be performed as described by Choe (1). Repeat transvaginal tape
(2) may be considered but carries with it the duplicate expense for
the repeat tape. Though multiple options exist for the failed TVT (including
repeat TVT procedure, suburethral sling using an alternative material,
versus injectable) this procedure appears to be inexpensive, straight
forward, with an acceptable level of success.
References
1. Choe JM: Suprapubic sling adjustment: minimally invasive method of
curing recurrent stress incontinence after sling surgery. J Urol. 2002;
168: 2059-62.
2. Riachi L, Kohli N, Miklos J: Repeat tension-free transvaginal tape
(TVT) sling for the treatment of recurrent stress urinary incontinence.
Int Urogynecol J Pelvic Floor Dysfunct. 2002;13: 133-5; discussion 135.
Dr.
Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA |