Treatment of recurrent stress incontinence secondary to “tethered tape”

2 months after insertion of a suburethral tape (Classic-TVT, in domo), a 71-year-old female patient complains of persistent bladder voiding dysfunction, severe urge symptoms, and involuntary loss of urine when getting up from sitting.Vaginal examination reveals a sufficiently estrogenized vagina and a well-healed suburethral colpotomy. Sonographically, a residual urine volume of 300 ml is measured. On further pelvic floor ultrasonography, the TVT presents orthotopically in the middle third at the junction with the distal third of the urethra, with a gap between urethra and sling of 2.6 mm. However, when patient exerts pressure dynamic examination shows, th at the ligament is fused to the vaginal wall Fg 3 at the proximal edge, in the form of a tethered tape and thus does not exert a correct function.This results in voiding dysfunction with postvoid residual urine, urge -, and recurrent stress-incontinence, especially when changing position.In a subsequent operation, the adhesion between the proximal edge of the ligament and the vaginal wall presents according to the sonographic examination. Urethrolysis is performed by dissecting the proximal edge of the ligament. The dissected proximal edge of the ligament is resected. A transurethral catheter is placed for 24 hours.After removing the catheter no increased residual urine is measured by repeated sonography. A few days post surgery the pelvic floor sonography shows the sling still in orthotop position with a distance between urethra and sling of 28 mm and without any sign of tethered tape ([Abb. 1]).

Abb. 1  Tethered tape (a).

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Artikel online veröffentlicht:
11. Oktober 2022