The foregoing discussions bring up some not insignificant ethical questions for surgeons faced with failed MUS operations. If tape “rescue surgery” restores continence in the manner of the MUS, which it does, is it ethical to perform a lesser procedure? The tape rescue operation restores the natural closure mechanisms much in the same way as the hemostat test restores closure and continence, fig.1. In contrast, Bulkamid works by compression of the urethra. By definition it reduces urethral diameter, laying the patients open to all the consequences of exponentially reduced urine flow as per fig.2. Its action is not physiological, and this is reflected in the poor results of the Itkonen RCT, 59% vs 95% patient satisfaction [2]. Suggestions for a return to largely discarded operations such as fascial bladder neck slings and Burch Colposuspension for cure of SUI [1] is a more serious ethical problem. These are major operations which require a high level of skill which only comes after years of practice. The “rescue operation” is well within the skill set of surgeons who are familiar with the MUS. It is worth serious consideration as a first-choice operation for failed MUS.

Ethics NA

Financial assistance NA

Conflicts NIL