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“The mid-urethral sling (MUS) procedure is the most common treatment modality for women with stress urinary incontinence (SUI). Although this procedure is highly successful, 5–20% of patients undergoing MUS experience persistent or recurrent SUI, regarded as surgical failure. However, little is known about methods to evaluate and manage patients who fail MUS procedures. The surgical options in these patients include bulking agent injection, shortening of pre-implanted tape, pubovaginal sling and repeat MUS. Of these STA-9090 clinical trial secondary procedures, repeat MUS is the most widely studied, although this

has been limited to small case series without long-term follow-up. Repeat MUS for prior MUS failure has shown relatively good success rates, ranging from 55 to 90%, with better outcomes obtained using the retropubic rather than the transobturator route. Persistent or recurrent SUI may also be successfully managed with less invasive techniques, such as tape shortening and periurethral injection of a bulking agent. Transurethral injection therapy for primary SUI has shown success rates of more than 65% at 1 year; however, PLX3397 these decreased significantly

thereafter to around 30% at long-term follow-up. Since the optimal management of recurrent or persistent SUI after MUS has not yet been established, long-term, prospective, randomized trials are warranted. Mid-urethral sling (MUS) procedures are currently the first-line surgical treatment option for female stress urinary incontinence (SUI). Since the tension-free vaginal tape (TVT) procedure was first introduced in 19961 various MUS procedures, involving modifications of this technique, have been widely used in clinical practice, including transobturator tape (TOT)2 tension-free vaginal tape obturator (TVT-O)3 and one-incision

MUS procedures.4 TVT has shown objective and subjective cure rates after 11 years of 84–90 and 77%, respectively,5,6 and TOT and TVT-O are associated with similar efficacy after 5 years7,8 Despite these successful outcomes, 5–20% of patients who undergo MUS are regarded as surgical failures.9 The increased number of patients who have failed this procedure has increased interest in appropriate secondary procedures. Many factors may be related to sling failure, including intrinsic sphincter deficiency (ISD), urethral hypermobility,10 inadequate tape material,11 obesity, presence see more of mixed incontinence,12 and inadequate surgical technique, whereby the sling is not placed at the mid-urethra or is applied too loosely.13 However, different studies often provide contradictory results, indicating that the etiology of MUS failure is uncertain, and making it difficult to determine how best to treat failed slings. Current treatment options for persistent or recurrent SUI after MUS procedure include injection of a bulking agent, retropubic suspension, a pubovaginal sling procedure, shortening of the pre-implanted tape or repeat MUS.