Currently, midurethral sling is widely used as a standard treatment in stress urinary incontinence (SUI) patients. According to several studies, the failure rate of midurethral sling (MUS) has been reported to be approximately 5-20%. In general, the sling failure can be defined as the state that SUI persists even after the surgery or that incontinence is improved temporarily and then recurs. Additionally, it can be widely regarded as a failure that the cases requiring secondary surgery due to mesh exposure, postoperative voiding difficulty, de novo urgency/urge incontinence, and severe postoperative pain, etc. Because of the lack of a large-scale study with high quality, there has been no clear guideline for second-line management yet. To date, transurethral bulking agent injection, tape shortening, repeat MUS, pubovaginal sling (PVS) using autologous fascia, and Burch colposuspension are available options for second-line surgery. Repeat MUS is the most widely used method as a second-line surgery at present. Bulking agent injection has lower durability and efficacy compared to other treatments. Tape shortening demonstrates a relatively lower success rate but comparable outcome if the period from first treatment to relapse is short. In patients with intrinsic sphincter deficiency (ISD), PVS and retropubic (RP) MUS can be considered first as second-line management because of higher success rate compared to other treatments. When revision or reoperation is required due to prior mesh-related complications, PVS or colposuspension, which is performed without a synthetic mesh, is appropriate for the second-line surgery. For the patient with detrusor underactivity, the re-adjustable sling can be a better option because of the high risk of postoperative voiding dysfunction in PVS or RP sling.

中文翻译：

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尿道中段吊带失败后的二线手术管理。

当前，在压力性尿失禁（SUI）患者中，中尿道吊带被广泛用作标准治疗方法。根据几项研究，据报道，中尿道吊带（MUS）的失败率约为5-20％。通常，吊带故障可以定义为即使在手术后SUI仍然持续或暂时性尿失禁得到改善然后再发的状态。此外，由于网片暴露，术后排尿困难，新生尿急/急迫性尿失禁以及严重的术后疼痛等原因，需要进行二次手术的病例被广泛认为是一种失败。高质量，目前还没有明确的二线管理指南。迄今为止，经尿道填充剂注射，胶带缩短，重复MUS，使用自体筋膜的耻骨阴道吊带（PVS）和Burch colposuspenpenpension是二线手术的可用选项。重复MUS是目前作为二线手术使用最广泛的方法。与其他治疗方法相比，填充剂注射剂的耐久性和功效较低。如果从首次治疗到复发的时间较短，则缩短磁带会显示出相对较低的成功率，但结果相当。对于内在括约肌缺乏症（ISD）的患者，PVS和耻骨后（RP）的MUS可被认为是二线治疗，因为与其他治疗相比，其成功率更高。当由于先前的网孔相关并发症而需要翻修或再次手术时，无需合成网孔即可进行PVS或闭塞术，适用于二线手术。