Urodynamic Examination Research Articles

The assessment of the lower urinary tract function in women after pelvis organ prolapse operations: objective and subjective criteria

Analysis of the results of surgical correction of pelvic organs prolapsed of 107 women with symptoms of lower urinary tract and connection between the measure of prolapse of pelvic organs and the nature of these symptoms was conducted. The role of urodynamics research in predicting the dynamics of the clinical manifestations of the women’s lower urinary tracts after surgical correction of pelvic organ prolapse was shown. It is noted that the results of urodynamic researches often do not coincide with subjective complaints of patients. Consequently women’s urodynamic examination of pelvic organ prolapse in conjunction with dysfunction of the lower urinary tract is advantageously carried out in conjunction with the analysis of subjective information receiveddue to filling in thequality life questionnaires by the patients. Such integrated approach allows us better understand the nature of the dysfunctions of the lower urinary tracts and to create appropriate expectations of the patient from the treatment.

Submucosal Administration of OnabotulinumtoxinA in the Treatment of Neurogenic Detrusor Overactivity: Pilot Single-Centre Experience and Comparison with Standard Injection into the Detrusor

Introduction: Apart from the standard intramural administration of botulinum neurotoxin A (BoNT/A) to the detrusor, intense research is taking place into new means of administration in view of the complex mechanism of action of BoNT/A. Methods: An open, randomised, prospective study was performed on a total of 23 patients with neurogenic detrusor overactivity. Following randomisation, patients were treated with 300 U of onabotulinumtoxinA (onaBoNT/A) in either the submucosa or the detrusor. Urodynamic examinations were carried out, and a bladder diary was kept both prior to and 12 weeks after the treatment. All patients stopped taking anticholinergics 1 week prior to the treatment. Results: In both the submucosa and detrusor groups, we recorded a significant improvement in the monitored urodynamic parameters and significant decreases in the frequency of urinary incontinence episodes following the treatment. A comparison of the two groups showed no significant difference between the two forms of application, with the exception of voided volume (p = 0.007). Conclusion: A comparison of the two administration methods did not show any significant difference between onaBoNT/A administration to the submucosa and to the detrusor. Thus, the submucosal injection of onaBoNT/A represents an equally effective approach for its administration to patients.

Time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy

Because time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy (MSA) are yet unknown, we aimed to determine these parameters through a combination of urodynamic examination and the results of a questionnaire on urinary symptoms. We retrospectively reviewed 66 patients with MSA who responded to a urinary symptoms questionnaire and underwent urodynamic examination more than twice. The participants' mean age was 62 years and mean disease duration at the first urodynamic examination was 3.2 years. Mean duration between the first and second urodynamic examination was 441 days. With regard to overall (both genders) time-dependent change, none of the urinary symptoms showed significant differences. In the urodynamic examination there were significant differences in reduced urine flow, increased post-void residuals, and decreased detrusor contractility at the second examination. With regard to gender differences, at the first examination, night-time urinary frequency, and voiding symptoms were significantly more severe in male than in female patients; however, at the second examination, except for urinary urgency, gender differences were not observed for any other symptoms. In urodynamic examination, the degree of detrusor contraction was significantly less in male patients at the first examination. However, no significant differences were found in urodynamic examination at the second examination. The present study indicates that voiding dysfunction progressed without significant worsening of voiding symptoms. In addition, gender differences are important in evaluating urinary dysfunction being basically less severe in female than in male patients, at least during the early stage. Neurourol. Urodynam. 33:516-523, 2014. © 2013 Wiley Periodicals, Inc.

Longitudinal observational cohort study about detrusor underactivity as a risk factor for bladder neck contracture after retropubic radical prostatectomy: preliminary results

To evaluate the association between preoperative detrusor underactivity (DU) and symptomatic bladder neck contracture (BNC) in patients undergoing radical retropubic prostatectomy (RRP), in order to identify a possible new risk factor in the etiopathogenic mechanisms of BNC after RRP. A total of 100 prostate cancer patients underwent RRP after preoperative complete urodynamic examination. Detrusor contractility was evaluated by bladder contractility index (BCI), power at maximum flow (WF-Qmax), and maximum velocity of detrusorial contraction (MVDC). Follow-up included uroflowmetry with bladder post-voiding volume evaluation at 3 and 6 months after surgery and repeated urodynamic examination at 12 months. Statistical evaluation was performed using the Student's t test (P < 0.01). The mean patient age was 65.6 ± 5.4 years, and pathological stage ranged from T2a to T2c. A total of 40 patients (40 %) presented normal detrusor contractility, 47 (47 %) mild DU, and 13 (13 %) severe DU. Detrusor overactivity (DO) was observed in 12 patients (12 %), small cystometric capacity in 10 (10 %), low compliance in 16 (16 %), DO plus DU (mild or severe) in 6 (6 %), and DO plus small cystometric capacity together with low compliance in 5 (5 %). Normal urodynamics were observed in 38 patients (38 %). Overall BNC incidence was 12. All patients with BNC presented preoperative DU; none presented DO or low bladder compliance. DU severity and BNC occurrence were significantly correlated (P < 0.01) for all 3 urodynamic parameters (BCI, WF-Qmax, and MVDC). We identify DU as a possible novel risk factor for BNC formation after radical prostatectomy that may contribute to its development.

Bacteriuria and urinary tract infection after urodynamic examination of spinal cord injury patients

Bacteriuria and urinary tract infection after urodynamic examination of spinal cord injury patients

Longitudinal changes in isovolumetric bladder pressure in response to age‐related prostate growth in 1,020 Healthy male volunteers

To non-invasively study if compensation and decompensation occurs in the urinary bladder of healthy male volunteers in response to benign prostatic enlargement (BPE) using the condom catheter method. Between 2001 and 2010, 1,020 healthy male volunteers were included in a longitudinal study based on three non-invasive urodynamic examinations during a 5-year follow-up. Inclusion criteria were an informed consent, the ability to void in a normal standing position and a minimum free flow rate of 5.4 ml/sec. Study parameters were prostate volume (PV), maximum free urinary flow rate (Q(max)) and bladder contractility, quantified by the maximum isovolumetric bladder pressure, measured in the condom (P(cond.max)). Volunteers also completed the International Prostate Symptom Score Form (IPSS). Within limitations, the included volunteers had a flat age distribution between 38 and 72 years. This made it possible to combine longitudinal analysis in a 5-year observation interval, with cross sectional analysis in a 35-year age range. Longitudinal analysis showed that with increasing age, PV increased with 1.9% per year, whereas Qmax decreased with 1.1% per year. IPSS increased with 1.1% per year when volunteers were older than 55 years. P(cond.max) increased during the 5-year longitudinal follow-up, but not in the cross sectional analysis. The difference between cross sectional and longitudinal results of the P(cond.max) may have been caused by compensation of the urinary bladder resulting in a selection effect. This would imply that compensation is a relatively fast process, taking approximately 5 years.

Correction of urodynamic disturbances in children with neurogenic bladder dysfunctions

The results of a complex urodynamic and psychological examination of 95 children with neurogenic bladder dysfunction are presented in this paper. It has been demonstrated that the degree of the neurogenic urodynamic disturbances has a linear direct dependence upon the marked character of anxiety. The application of dynamic electroneurostimulation in combination with M-cholinergic antagonist causes a potentiated therapeutic effect.

Transurethral plasma bipolar resection in the treatment of benign prostatic hyperplasia

Objective To investigate the transurethral plasma ion bipolar resection in the treatment of benign prostatic hyperplasia.Methods Clinical data of 135 patients with benign prostatic hyperplasia treated with the transurethral plasma bipolar resection were retrospectively analyzed.Results International prostate symptom score (IPSS) after treatment of urodynamic examination (maximum flow rate,bladder pressure,residual urine) were significantly better than before treatment,the differences were statistically significant (t =11.26,13.12,13.40,39.96,all P ＜ 0.05) ;the difference was not statistically significant in erectile score compared with pretreatment (t =0.74,P ＞0.05).Conclusion The transurethral plasma bipolar resection in the treatment of benign prostatic hyperplasia has good effect,safety,and it is worthy of clinical application. Key words: Prostatic hyperplasia; Electrosurgery

Randomized Controlled Trial for Salvia sclarea or Lavandula angustifolia: Differential Effects on Blood Pressure in Female Patients with Urinary Incontinence Undergoing Urodynamic Examination

The aim of this study was to investigate the effect of inhalation of Salvia sclarea (clary sage; clary) or Lavandula angustifolia (lavender) essential oil vapors on autonomic nervous system activity in female patients with urinary incontinence undergoing urodynamic assessment. STUDY DESIGN, LOCATION, AND SUBJECTS: This study was a double-blind, randomized, controlled trial carried out in 34 female patients with urinary incontinence. The subjects were randomized to inhale lavender, clary, or almond (control) oil at concentrations of 5% (vol/vol) each. Systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, and salivary cortisol were measured before and after inhalation of these odors for 60 minutes. The clary oil group experienced a significant decrease in systolic blood pressure compared with the control (p=0.048) and lavender oil (p=0.026) groups, a significant decrease in diastolic blood pressure compared with the lavender oil group (p=0.034) and a significant decrease in respiratory rate compared with the control group (p<0.001). In contrast, the lavender oil group tended to increase systolic and diastolic blood pressure compared with the control group. Compared with the control group, inhalation of lavender oil (p=0.045) and clary oil (p<0.001) resulted in statistically significant reductions in respiratory rate. These results suggest that lavender oil inhalation may be inappropriate in lowering stress during urodynamic examinations, despite its antistress effects, while clary oil inhalation may be useful in inducing relaxation in female urinary incontinence patients undergoing urodynamic assessments.

Significance of Urodynamic Examination in Patients with Spinal Cord Lesions and Verified Neurogenic Urination Dysfunction

Evaluation of neurogenic urination dysfunction by urodynamic examination in patients with spinal cord lesions is essential for ensuring the effective emptying of the bladder and the prevention of urological complications. To establish the relation between urodynamic findings with the development of complications of the upper urinary tract (UUT) in patients with spinal cord lesions. This is a retrospective study involving 42 patients with spinal cord lesions in which are analyzed complications of UUT incurred in an average 4-year period. It also included urodynamic examination of 41 patients (one patient with definitely placed catheter) and the results are compared with the found UUT complications. Among urodynamic parameters were compared the values of bladder compliance (C), maximum detrusor pressure in the filling phase (Pdet.max) and detrusor activity. UUT complications: nephrolithiasis 24%, ureteropieloectasia 21%, chronic pyelonephritis 10% and hydronephrosis in 5% of patients. In 26 (64%) patients were found low compliance (C < 20 ml/cmH2O), and preserved in 15 (36%) patients. Pdet.max. was significantly lower in patients with preserved compliance (p < 0.01). According detrusor activity was found 22 (54%) hyper reflex and 19 (46%) areflexic bladders. In the group with areflexic bladder, UUT complications has 7 (37%), in group of hyper reflex bladder 10 (45%) patients. In areflexic bladder with UUT complications was found significantly lower levels of compliance (p < 0.01) than in the group without complications. In our sample of patients with spinal cord lesions was demonstrated the impact of low compliance to the occurrence of UUT complications. It is also in case of the areflexic bladder found significant difference in compliance between the groups with and without UUT complications. Maintaining bladder compliance and low values if intracystic filling pressure the most important tasks in maintaining vesico-sfincteral balance, and thus prevention of urological complications in patients with spinal cord lesions.

Maintenance of the therapeutic effect of two high-dosage antimuscarinics in the management of overactive bladder in elderly women.

PurposeTo improve the long-term efficiency of the pharmacologic management of overactive bladder (OAB) in elderly women.MethodsThe study comprised 229 women (mean age, 66.3 years; range, 65-77 years) with urodynamically and clinically confirmed OAB. All patients received the most effective treatment regimen based on the data obtained in the initial part of the study (trospium 60 mg/day + solifenacin 40 mg/day, for 6 weeks), and positive results similar to those in the first phase were obtained. They were then divided into four groups, based on the maintenance therapy: group A (59 women), trospium (60 mg/day) + solifenacin (40 mg/day) for 1 month; group B (51 women), electrical stimulation of the detrusor muscle for 1 month; group C (63 women), laser puncture for 1 month; group D (56 women), placebo. Maintenance therapy was administered 2.5 months after completion of primary treatment. The patients' condition was monitored through the OAB questionnaire for 1 year and by urodynamic examination at months 6 and 7 from the start of the study.ResultsIn group A, the clinical and urodynamic results achieved after the initial + main treatment phase (two high-dosage antimuscarinics of different generations, trospium and solifenacin, for a total of 2.5 months) were maintained for at least 7 months. Electrical stimulation of the urinary bladder as a method of maintenance therapy proved to be less effective. In groups C and D, deterioration in results was observed at 6-8 months, which led us to conclude that laser puncture was an inefficient method of maintenance therapy in elderly women with OAB.ConclusionsMaintenance treatment of OAB in elderly women with a combination of high-dosage antimuscarinics is an effective method for reducing the risk of recurrence of the disease.

The treatment of neurogenic bladder dysfunction in patients with spinal cord injury

Neurogenic bladder dysfunction, resulted from demage to the neural structures in spinal lesion present a major problem for the patient, his environment and health care workers. Proper diagnosis of neurogenic bladder dysfunction allows you to implement appropriate treatment plan that will allow adequate emptying and prevention of complications that may endanger the patient's life. The evolution of spinal cord injuries can distinguish three phases: 1) spinal shock phase, 2) the recovery phase, 3) final phase. After spinal trauma bladder is affected mostly in two ways: 1) Spastic (reflex) bladder caused in lesion above voiding center (S2-S4 segments), 2) Flaccid (atonic) neuropathic bladder emerges in lesion at the voiding center (S2-S4) or below it, as well as lesions of the peripheral innervation of bladder, 3) Autonomic disreflection syndrome develops in patient with cervical or high thoracic spinal cord lesions, above the Th 1 segment, 4) Uninhibited neurogenic bladder develops in incomplete nerve pathway lesions in cerebral cortex, pyramidal pathway or in spinal cord-cerebral voiding control debilitate. The diagnosis of neurogenic bladder dysfunction is established by urodynamic examination, laboratory blood and urine findings as well as radiographic, computed tomography and nuclear magnetic resonance imaging of the spinal column. Bladder emptyng can be made by intermitetnt catheterization, Crede's procedure, suprapubic stimulation, smooth bladder muscle electrostimulation and by medications. The necessity of an Interdisciplinary approach to the treatment of these patients indicates all hardness in spinal cord injury patientes and consequent bladder dysfuncion.

Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

An observational study. To investigate the factors associated with silent autonomic dysreflexia (AD) during urodynamics (UD) in spinal cord injury (SCI) patients. Taichung city, Taiwan, ROC. Blood pressure (BP) and symptoms of AD were continuously monitored during UD, and systolic blood pressure (SBP) elevations >20 mmHg was considered an AD reaction. AD patients were divided into a symptomatic group and a silent group (without AD symptoms), and variables (basic demographic data, hemodynamic data and UD parameters) were compared. A total of 42 patients, 21 in symptomatic and 21 in silent AD groups, were analyzed. Symptomatic group had significantly greater diastolic blood pressure (DBP) increment and rates of SBP/DBP changes (change of BP divided by duration) as compared to the silent group (29.5 vs 21.7 mmHg; 4.8 vs 2.3 mmHg min(-1) and 2.8 vs 1.4 mmHg min(-1)) (P<0.05). The cutoff points of these three variables, determined by receiver operating characteristic analysis, are: DBP increment of 21 mmHg and rates of SBP/DBP change of 2.27 and 1.16 mmHg min(-1). Age had a weak negative correlation with DBP change (Pearson's r=-0.377, P=0.048) and the silent group was significantly older than the symptomatic group (49.4 vs 40.1 years, P<0.05). Patients with more symptomatic AD tended to have significant DBP elevation and more rapid SBP/DBP increments, and this was negatively correlated with age. Aging decreases AD symptoms and the magnitude of DBP elevation, possibly through the mechanism of decreased baroreceptor sensitivity. BP monitoring during UD and other invasive procedures is strongly recommended, especially for elderly SCI patients.

English

The current study aims to explore the possible correlations between detrusor excitability and the expression of&nbsp;C-kit and connexin-43 (Cx43). Fifty-two adult female Sprague Dawley (SD) rats were randomly divided into the normal control (NC), supra-sacral cord injury (SSCI) and sacral cord injury (SCI) groups. Neurogenic bladder models were established. Urodynamic examination, bladder pathological observation and detrusor muscle excitability detection were performed. Meanwhile, the expression of C-kit and Cx43 was detected using immunohistochemistry and Western blot analysis. The detrusor leak point pressure of the SSCI group increased significantly compared to the NC group, whereas that of the SCI group decreased significantly. The spontaneous detrusor muscle contraction frequency of the SSCI group increased significantly compared to the NC group, whereas that of the SCI decreased significantly. The C-kit and Cx43 positive expression in the SSCI was significantly higher than that in the control group, whereas that in the SCI group was significantly lower (P&nbsp;&lt; 0.01) The C-kit and Cx43 protein content in the SSCI group was significantly higher compared to the NC group, whereas that in the SCI group was significantly lower (P&nbsp;&lt; 0.01).&nbsp;Changes in excitability and the expression of C-kit and Cx43 expression contribute to the occurrence of detrusor hyperreflexia and areflexia. &nbsp; Key words:&nbsp;Spinal cord injuries, detrusor hyperreflexia, detrusor areflexia, urodynamics, C-kit, connexin-43.

Effects of sildenafil on bladder compliance and endothelin-1 in rabbit model of partial bladder outlet obstruction

To explore the effects of sildenafil on bladder compliance and endothelin-1 in the rabbit model of partial bladder outlet obstruction. A total of 24 adult male New Zealand white rabbits were randomly divided into group A, group B, group C and group D (n = 6 each). The rabbit model of partial bladder outlet obstruction was established in groups C and D while groups A and B underwent a sham operation. Daily sildenafil (10 mg/kg) was dosed to groups B and C by lavage. Daily normal saline was dosed similarly to groups A and D. Bladder urodynamic examinations were conducted in each group at Week 16. Then bladder was isolated and weighed from each group. And ET-1 in bladder tissue was measured by ELISA. Pressure thresholds for voiding (PT) in A-D groups were (10.6 ± 2.0), (11.6 ± 2.7), (14.0 ± 4.2) and (20.4 ± 6.1) cm H2O respectively. Compared with groups A, B and C, PT in group D was significantly higher (all P < 0.01). Bladder compliance in 4 groups were (2.75 ± 0.51), (2.78 ± 0.46), (4.98 ± 2.15) and (1.22 ± 0.25) ml/cm H2O respectively. Compared with groups A, B and C, bladder compliance was significantly lower in group D (all P < 0.01). Bladder compliance in group C was higher than that in groups A and B (both P < 0.01). The weights of bladder specimens in 4 groups were (5.0 ± 0.4), (4.6 ± 0.4), (8.2 ± 1.3) and (17.9 ± 2.3) g respectively. Compared with groups A and B, the weights of groups C and D were significantly heavier (all P < 0.01). And the weight of group D was much greater than that of group C (P < 0.01). The contents of ET-1 in bladder tissue of 4 groups were (72 ± 19), (69 ± 18), (76 ± 21) and (106 ± 29) pg/g respectively. Compared with groups A, B and C, ET-1 in bladder tissue was significantly higher in group D (all P < 0.05). Daily sildenafil can effectively alleviate the damage of rabbit bladder compliance from partial bladder outlet obstruction and protect bladder functions. Its mechanism may be related with the down-regulation of ET-1 in bladder tissue of partial bladder outlet obstruction.

Laparoscopic radical cystectomy with orthotopic ileal neobladder in the treatment of invasive bladder cancer

To study the technique and outcomes of laparoscopic radical cystectomy (LRC) and evaluate the efficacy of the urinary reservoir constructed with ileum in patients with invasive bladder cancer. From 2005 - 2010, A total of 11 patients with bladder cancer were enrolled in this study. Laparoscopy was performed with 5 trocars. Urodynamic examination was performed, the function of upper urinary tract was tested, and complications were evaluated in all the eleven cases. The mean operation time was 420 minutes (ranged 350 to 490 min) and mean blood loss was 410 ml (ranged 300 to 700 ml). Ten of the 11 patients had complete continence, and one case had incontinence. The average flow rate was 11.5 ml/s. The first pressure of the reservoir was 29 cm H2O, and the maximum pressure was 36 cm H2O. The average capacity was 162 ml and 410 ml, respectively. The outlet pressure was 49 cm H2O. The volume of residual urine was 0 - 35 ml. No evidence of ureteral reflux was noted. Laparoscopic radical cystectomy is a promising method for the treatment of bladder cancer. Orthotopic ileal neobladder is considered as an ideal form of urinary diversion characterized with low pressure, larger capacity and continence.

Editorial Note on: Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management

Editorial Note on: Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management

Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management

Non-interventional, descriptive-observational cohorts study. To assess the incidence of urinary tract infection (UTI) after urodynamic examination in patients with spinal cord injury (SCI) according to bladder management. Level 1 trauma center. Between January and December 2010 a total of 133 consecutive, hospitalized SCI patients were included and classified according to their bladder management. Urine specimen was obtained at the beginning of the urodynamic studies (UDS) and 3-5 days thereafter. 'Significant bacteriuria' (SBU) is defined by a CBU per ml level ≥10(5) in a urine culture. UTI thus is defined as a combination of a SBU and ≥100 leukocytes per μl in urine analysis. The overall incidence of UTI post UDS was 15.79%. In patients with sterile urine prior to urodynamics UTI was ascertained in 8.6% (de-novo-UTI). In contrast, 32.5% of the patients with SBU prior to UDS showed UTI 3 days later. There were only minor differences in the incidence of de-novo-UTIs in SCI patients who emptied their bladder by intermittent self catheterization or intermittent catheterization by attendant (8.82% and 6.67%, respectively). In SCI patients with reflex voiding however, the frequency of de-novo-UTIs was twice as high (14.28%). The recommendation of antibiotic prophylaxis for all SCI patients undergoing urodynamic examination is not commonly accepted and according to our data not justified. However, the analysis of subgroups revealed that SCI patients with unsuspected SBU prior to UDS and patients with reflex voiding are possibly at higher risk to acquire post-UDS infection.

Vaginal sacrocolporectopexy for the surgical treatment of uterine and vaginal vault prolapses: confirmation of the surgical method and perioperative results of 101 cases

In this study, we sought to confirm the surgical method of vaginal sacrocolporectopexy and previously reported positive perioperative results of this procedure in a large patient group. We describe the approach which offers a vaginal, safe alternative to sacrospinous repair, laparoscopic or open vaginosacropexy and the use of synthetic meshes to treat pelvic organ prolapse. We conducted a monocentric, prospective, nonrandomized study for treatment of patients with uterine and vaginal vault relapse (grade 2-4). All patients underwent a preoperative urogynecological urodynamic examination. We focus on method, operative time, complications, blood transfusions, hospital stay and clinical data. Between March 2006 and March 2011, 101 consecutive patients of mean age 64 (40-89) years, with sub or total uterine prolapse (n=69, grade 2-4) and vaginal vault prolapse (n=32, grade 2-4) were treated with vaginal sacrocolporectopexy. Cystocele (grade 2-4) was found in 88 (87.1%) and rectocele (grade 2-4) in 43 (42.5%) patients. Mean duration of surgery with sacrocolporectopexy was 70 min (28-165) without hysterectomy, and 76 min (40-219) with hysterectomy. Regression analysis of all patients (n=101) showed a significant decrease of operative time in the group without hysterectomy after 40 cases. Three bladder lesions, two in patients with a history of hysterectomy, occurred during surgery and were corrected intraoperatively without further complications. No patient required a blood transfusion. Hemoglobin levels decreased slightly from a preoperative mean of 13.6 mg/dl (10.3-15.7) to a postoperative mean of 11.7 mg/dl (8.6-14.7). Vaginal sacrocolporectopexy is a safe vaginal method for the treatment of sub-/total uterine/vaginal vault prolapse.

Secondary Transobturator Tape Procedure after Combined Pelvic Organ Prolapse Repair

A 66-year-old female who underwent a partial urethrectomy complained of severe incontinence due to intrinsic sphincter deficiency. Bone anchor surgical technique was performed, but in 3 years, serious pelvic organ prolapse had occurred. Consequently, anterior and posterior tension-free vaginal mesh operation was planned. Preoperative urodynamic examination predicted postoperative stress incontinence, and concurrent transobturator tape (TOT) surgery was performed. After 3 months, stress incontinence reoccurred, and secondary TOT was performed. Relapse was probably caused by dislocation of the first TOT towards the bladder neck. Thus, the secondary TOT was placed distal to the initial tape towards the external urethral meatus, and proper tension was applied. After the operation, stress incontinence was cured. Thus, a second TOT procedure, with proper positioning and tensioning, can effectively cure stress incontinence that occurs after an initial TOT procedure.