[The solution of persistent stress urinary incontinence in women when surgery with the TVT-SECUR* is unsuccessful]

A Martan, K Svabík, J Masata, T Koleska, R El-Haddad, M Pavlikova
Ceská Gynekologie 2009, 74 (1): 3-7

OBJECTIVE: The objective of this study is to evaluate the efficacy of the procedure of shortening the tape in the treatment of persistent stress urinary incontinence when the tension-free vaginal tape (TVT) SECUR procedure proves unsuccessful.

DESIGN: Retrospective study.

SETTINGS: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General Teaching Hospital, Prague.

MATERIALS AND METHODS: Eight patients with persistent stress urinary incontinence (SUI) after the TVT-S procedure were included in our study. In order to resolve their condition, the tape was shortened. We used the overlap and the cut-off technique. Pre- and postoperative urodynamic and ultrasound (US) examinations were carried out, and the efficacy of this procedure was evaluated by cough test, pad-weighting test (PWT) and by the questionnaires Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ12) and the International Consultation on Incontinence Questionnaire--Short form (ICIQ-UI SF). All data were processed and statistical analyses performed in statistical environment R, version 2.5.1.

RESULTS: In six patients the cough test and PWT were negative after reoperation, indicating no stress urinary incontinence, while in two patients mild leakage of urine persisted. The reoperation significantly increased the value of Maximum Urethral Closure Pressure (MUCP) while coughing. From the US examination we can conclude that the tape is tightened closer to the urethra and pubic bone.

CONCLUSIONS: We describe a method--shortening the tape--for the treatment of persistent stress urinary incontinence when the TVT-S procedure fails. Based on our results we have established that this procedure is simple and as effective as inserting a new tape, but cheaper.

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