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

Objectives: 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. Methods: 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 57months (range 12-96). Pre- and postoperative urethral mobility and urodynamics were evaluated. Results: 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 5g/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. Conclusions: 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.