**5. Revision urethral sling surgery**

The literature is maturing with regard to the appropriate choice for a repeat sling following midurethral sling for SUI. Stav and colleagues reviewed the cases of 1225 retrospectively identified women who underwent either a retropubic or transobturator sling. 91% of these patients completed a telephone interview questionnaire. (Stav et al. 2010) The majority of these women had a retropubic sling as opposed to a transobturator sling. Mean follow up was 50 months. Their re-operation rate for failure was 14%. Repeat retropubic sling placement was significantly more successful than utilizing a transobturator approach (71% vs 48%, p=0.04). Repeat slings were placed without removal of the previous sling. Most surgeons will opt to use a retropubic sling for recurrent incontinence and rather than a transobturator sling because of the greater urethral tension generated. Management options also include repeat placement of a "tight" pubovaginal sling with the intent of putting the patient in urinary retention. This can be done utilizing autologous fascia as well.
