Tension‐free vaginal tape retropubic sling for recurrent stress urinary incontinence after Burch colposuspension failure

Abstract

To verify the efficacy and to clarify the mechanism of the tension-free vaginal tape retropubic sling for recurrent stress urinary incontinence after Burch colposuspension failure. A total of 24 women having tension-free vaginal tape retropubic sling placement for recurrent stress urinary incontinence after a previous failed Burch urethropexy were enrolled in the present study. Median follow up was 57 months (range 12-96). Pre- and postoperative urethral mobility and urodynamics were evaluated. Preoperatively, all 24 patients had intrinsic sphincter deficiency and 14 had urethral hypermobility. Postoperatively, 15 patients were completely dry and two had a leakage of urine less than 5 g/h. The overall success rate was 70.8%. There was a significant postoperative increase of maximum urethral closure pressure (P < 0.001), and a decrease of average flow rate (P = 0.001) and urethral hypermobility (P < 0.001). When comparing successful with failure cases, only elevated maximum urethral closure pressure (P = 0.002) was significantly different. Multivariate logistic regression showed the change of maximum urethral closure pressure (P = 0.011) was the only independent parameter significantly correlated with the outcome of sling placement. Recurrent stress urinary incontinence with intrinsic sphincter deficiency after Burch colposuspension might be well treated with the tension-free vaginal tape retropubic sling by effectively elevating the maximum urethral closure pressure.