Effectiveness of the TVT procedure as a repeat mid-urethra operation for treatment of stress incontinence

Introduction and hypotheses  The aim was to evaluate the long-term (5 years) effect of performing a retropubic tension-free vaginal tape (TVT) operation after a prior failed mid-urethra sling procedure and try to identify reasons for failure of the primary operation. Methods  We identified 26 women to whom a repeat mid-urethra sling procedure (using the TVT Gynecare device) had been performed. Both the primary and repeat operations were retropubic procedures. Four different tape materials had been utilized in the primary procedure. Results  Twenty women (77%) of the identified 26 women participated in the study. Seventy-five percent of the women were cured or significantly improved after the repeat TVT procedure. Reasons for failure of the primary procedure were grouped as follows: inadequate tape material (four out of 20), inadequate surgical technique (six out of 20), patients' medical condition (four out of 20), and unrecognized reasons (six out of 20). Conclusions  A retropubic mid-urethra sling operation can be considered after failed mid-urethra sling surgery.