Tension-free vaginal tape procedure for treatment of USI: subjective and objective efficacy evaluation

Urinary incontinence is a frequent functional disease affecting 5% to 25% of women. It is commonly believed that urinary stress incontinence (USI) is caused by anatomical defects, thus it can be treated by restoring anatomy. More than 100 surgical techniques have been proposed for genuine stress incontinence treatment. The tension free vaginal tape procedure (TVT) for the treatment of genuine IUS in women was first reported in 1996 by Ulmsten et al. The purpose of this study was to evaluate objective and subjective efficacy of the TVT procedure in different types of female urinary incontinence. From February 2000 to December 2001, 52 patients with urinary incontinence underwent the TVT procedure in the Obstetric and Gynecology Department of Avezzano Hospital, Italy. No difference in the cure rates was found between patients undergoing the TVT alone or associated with anterior and/or posterior colporrhaphy. In accordance with many authors we can affirm that the TVT sling technique is easy to use, the time for surgery is relatively short, and the procedure is free of complications and provides a satisfactory outcome.     

Analysis of complications of the tension-free vaginal tape procedure for surgical treatment of female stress urinary incontinence

OBJECTIVE: The most common types of urinary incontinence in women are stress, urge and mixed incontinence. Stress urinary incontinence may be caused by an urethral hypermobility and internal sphincter deficiency (ISD). There are over 100 different surgical procedure for the treatment of female stress incontinence. Tension-free vaginal tape (TVT) is a new anti-incontinence surgical technique which was first described by Ulmsten in 1996. The aim of the study was to evaluate the complications of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence. METHODS: The study group was consisted of 162 women, aged 32-84. All patients had a basic evaluation that included a history, frequency/volume chart, questionnaire of micturition (self-made), physical examination, stress test, Bonney test, urinalysis and bacterial culture of urine. Women with mixed urinary incontinence and who underwent surgical treatment of SUI in the past had been done urodynamic investigation. The operation was carried out under epidural, subarachnoid and general anesthesia. The TVT procedure was performed as described by Ulmsten. The follow-up was done after 1 day, 1 and 3 and 6 months since the operation. RESULTS: Among complications related to the procedure were 11 cases of cystotomy, 5 cases of urinary retention requiring four days catheterization, 3 cases of bleeding from the vagina, 14 cases of detrusor instability de novo. In 4 cases occurred postoperative obstinate pain. In 4 cases occurred recurrent urinary tract infection. None complication required invasive treatment. No evidence of defect healing or rejection of the tape was found. CONCLUSIONS: We conclude that the TVT procedure is safe method of the surgical treatment of urinary stress incontinence associated with a low complications.     

Tension-free vaginal tape (TVT) in women with low urethral closure pressure

OBJECTIVE(S): Aim of the study was to assess the effectiveness and the complications associated with the use of tension-free vaginal tape (TVT) in women with stress urinary incontinence and low urethral closure pressure (LUCP). STUDY DESIGN: Thirty-seven patients with stress urinary incontinence and LUCP who were treated with the TVT procedure have been included in the study. Physical examination and urodynamic investigations were carried out to all women preoperatively and at 6, 12 and 26 months (average, range: 22-30 months), postoperatively. The mean age of the patients was 69 years (+/-13), while mean parity was 2.2 (range 0-3). RESULTS: TVT procedure was carried out in all patients with epidural anesthesia. Postoperative evaluation showed 27 patients (73%) to have been completely cured, four (9.25%) to have a considerable improvement, whereas six patients (16.2%) were classified as failures. Only a few complications occurred. CONCLUSION(S): Our study indicates that the TVT procedure is an effective and well-accepted minimal invasive surgery for treatment of urinary stress incontinence in women with LUCP. The cure rate of 73% could be considered satisfactory. Women with LUCP and 'fixed' urethra, are at significantly increased risk of failure of the procedure.     

Concomitant tension-free vaginal tape for urinary incontinence during laparoscopic hysterectomy

OBJECTIVE: To evaluate the effectiveness and safety of placing tension-free vaginal tape (TVT) during a laparoscopically assisted vaginal hysterectomy (LAVH) in women with stress urinary incontinence and coexistent benign gynaecological disease. DESIGN: Retrospective clinical study (Canadian Task Force classification II-2). SAMPLE: Thirty patients diagnosed with genuine stress incontinence and benign gynaecological disease were studied. METHODS: All the patients underwent LAVH and concomitant TVT procedure. RESULTS: There was no significant difference in urodynamic parameters before and after surgery. All patients were followed postoperatively for a mean duration of 24.6 +/- 11.5 months (range 12-40). The cure rate of stress urinary incontinence was 96.7%. CONCLUSIONS: Concomitant placement of tension-free vaginal tape during a laparoscopically assisted vaginal hysterectomy proved to be an efficacious and safe procedure for women with benign gynaecological disease and coexistent stress urinary incontinence.     

Use of the TUT (Tension-free Vaginal Tape) in the treatment of female urinary stress incontinence. Preliminary results

BACKGROUND: The Tension-free Vaginal Tape (TVT) represents the most recent technique for the treatment of genuine stress urinary incontinence (GSUI). The various number of surgical procedures proposed for the treatment of GSI very often do not lead to a complete remission of this pathology. The data from the literature show how TVT is a effective procedure for the treatment of female urinary incontinence. METHODS: Twenty-nine women with diagnosis of urinary incontinence underwent application of polypropilene band (TVT: tension-free vaginal tape) underneath the uretra, in order to treat this disorder. The procedure has been carried out in peripheral anesthesia. RESULTS: A complete remission of the urinary incontinence was obtained in 24 patients. In the remaining cases there was an improvement of the symptoms in two patients, whereas in two patients remained a secondary detrusor instability. In one case the external iliac vein was perforated thus requiring a surgical repair. CONCLUSION: The short surgical time, the feasibility of the procedure and the following short hospitalization made this technique well accepted either by the surgeons ang the patients. Moreover the possibility to carry out the procedure in peripheral anesthesia allows to have the collaboration of the patient. However this technique is not free of risks, how the serious complication we had can demonstrate.     

A three-year postoperative evaluation of tension-free vaginal tape

The aim of this study was to evaluate the outcome of tension-free vaginal tape (TVT) 3 years after surgery. Fifty-one women (mean age 52.9) with a genuine stress incontinence underwent the TVT operation. In 10 patients, a prolapse repair was also done simultaneously. The majority of the patients were operated under local anesthesia. All patients were evaluated 3 years after the procedure using a protocol for objective and subjective assessment of the outcome including an evaluation of quality of life related to urinary incontinence. According to the protocol, 46 women (90%) were successfully cured, another 3 patients (6%) were improved, whereas 2 patients (4%) were classified as failures. Few complications occurred. We conclude that TVT is a simple and well-accepted minimal invasive surgery for treatment of female urinary stress incontinence. The outcome 3 years after the operation showed no signs of deterioration compared to the results shortly after surgery. The cure rate of 90% is comparable with the best results of other surgical treatments for female urinary incontinence. Copyright Copyright 1999 S. Karger AG, Basel     

Concomitant surgery with tension-free vaginal tape

BACKGROUND: To evaluate the efficacy and feasibility of tension-free vaginal tape (TVT) surgery combined with gynecologic surgery using general anesthesia. METHODS: One hundred and six women with genuine stress incontinence (GSI) diagnosed with a traditional urodynamic examination were prospectively enrolled into this study. All of the 106 women underwent TVT surgery for the treatment of GSI, along with a concomitant hysterectomy procedure, under general anesthesia. We estimated the severity of incontinence symptoms on a visual analog scale (VAS), and used a questionnaire for subjective assessment before and after TVT surgery. The objective assessment of urinary incontinence was carried out with a 1-h pad test and traditional urodynamic examination. Of the 106 patients, 50 had uterine prolapse and underwent transvaginal hysterectomy and anteroposterior colporrhaphy (APC), and another 50 had uterine myoma and underwent laparoscopic-assisted vaginal hysterectomy (LAVH). RESULTS: The follow-up mean interval was 18 months (range 12-36 months). The 50 women undergoing LAVH and TVT surgery had a mean hospitalization of 3.5 days. The subjective success rate was 90.5% and the objective success rate was 86.8%. The other group of 50 women undergoing vaginal total hysterectomy (VTH), APC and TVT surgery had a mean hospitalization of 4.8 days. The subjective success rate was 88.6% and the objective success rate was 84.9%. There were six patients lost to follow-up for several reasons. The rates of complications of bladder perforation, postoperative voiding difficulty and postoperative urinary urgency were 2%, 11% and 10%, respectively; neither pelvic hematoma requiring blood transfusion nor conversion to laparotomy occurred. CONCLUSION: The results of this study prove that the TVT procedure, performed under general anesthesia without the need for the intraoperative cough provocation test to treat GSI, and carried out concomitantly with other gynecologic surgeries, is safe and effective.     

TVT手术在女性压力性尿失禁中的应用

目的 :探讨TVT手术作为治疗女性压力性尿失禁新手术方法的有效性。方法 :回顾性分析自 2 0 0 1年 5月以来 ,我院应用TVT手术治疗女性压力性尿失禁的临床疗效及并发症。结果 :17例尿失禁患者 (其中 13例压力性尿失禁 ,4例混合性尿失禁 )接受TVT手术 ,15例 ( 88 2 % )术后排尿功能恢复良好 ,2例 ( 11 8% )发生排尿困难 ,均经持续导尿、膀胱训练及药物治疗后恢复正常排尿功能。VTV手术的成功率为 10 0 %。结论 :TVT手术具有简单、微创、恢复快等特点 ,是治疗女性压力性尿失禁的安全有效方法     

Colpocleisis and tension-free vaginal tape sling for severe uterine and vaginal prolapse and stress urinary incontinence under local anesthesia

STUDY OBJECTIVE: To describe the technique, complications, and outcomes of vaginal repair of concomitant advanced uterine and vaginal prolapse and stress urinary incontinence using colpocleisis and tension-free vaginal tape (TVT) and pubovaginal sling under intravenous sedation and local anesthesia in elderly and/or medically compromised patients. DESIGN: Retrospective analysis (Canadian Task Force classification III). SETTING: Large tertiary care hospital with university affiliation. PATIENTS: Thirty consecutive women. INTERVENTION: Colpocleisis and TVT-pubovaginal sling. MEASUREMENTS AND MAIN RESULTS: Data were obtained by retrospective chart review of office and surgical records and follow-up physical examinations. All 30 patients had the procedure completed without general anesthesia. Mean estimated blood loss was 56 ml (range 10-150 ml), mean operating time 97.3 minutes (range 65-135 min), and mean hospital stay 1.62 days (range 1-12 days). No intraoperative complications occurred, although one woman experienced a postoperative myocardial infarction. Average follow-up was 19.1 months. Three women required reoperation for minor prolapse (2 posterior repairs, 1 anteroposterior repair) and 94% were cured of stress incontinence. CONCLUSION: Preliminary data suggest that surgical correction of concomitant severe pelvic organ relaxation and stress urinary incontinence using a proved procedure (pubovaginal sling) coupled with colpocliesis can be performed rapidly and safely with local anesthesia and mild sedation, thus limiting the potential risks of general anesthesia and more invasive surgical procedures.     

Tension-free vaginal tape procedure on genuine stress incontinent women with coexisting genital prolapse

OBJECTIVE: To study the efficacy of performing the tension-free vaginal tape (TVT) procedure concurrently with vaginal pelvic relaxation surgeries in the management of genuine stress incontinence with genital prolapse. MATERIALS AND METHODS: Fifty-eight women were surgically managed. Various vaginal pelvic reconstructive surgeries for prolapses were completed before the TVT procedure. Pre-operative and postoperative urodynamic studies, 1-h pad tests and symptom analysis were evaluated 1 year postoperatively. Surgical procedures and patient outcomes are discussed. RESULTS: Objective data available for 55 patients. Fifty (91%) were dry 1 year postoperatively. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies and sacrospinous ligament fixations. No major surgical complications occurred. The average blood loss was 134 ml, the average operating time for the TVT procedure was 21 min, and the average postoperative hospital stay was 3.4 days. All patients voided spontaneously with adequate volumes of postvoid residual urine before being discharged. Two patients had a recurrent prolapse. Urodynamic parameters showed no significant differences before and after the surgery, except that the parameters related to voiding dysfunction were improved in the patients with severe cystocele. De nova detrusor instability was observed in one patient. CONCLUSIONS: The tension-free vaginal tape procedure performed with concurrent vaginal pelvic relaxation surgery is safe and effective for genuine stress incontinence and pelvic prolapse. Concomitant procedures also appear to relieve bladder outlet obstructions caused by severe prolapse.     

Tension-free vaginal tape compared with laparoscopic Burch urethropexy

STUDY OBJECTIVE: To compare laparoscopic Burch colposuspension and tension-free vaginal tape (TVT) procedure in women with genuine stress incontinence. DESIGN: Randomized clinical study (Canadian Task Force classification I). SETTING: Tertiary care university hospital. PATIENTS: Forty-six consecutive women. INTERVENTION: Laparoscopic Burch colposuspension (23) and TVT procedure (23). MEASUREMENTS AND MAIN RESULTS: Valsalva leak-point pressure increased after surgery in both groups, but TVT substantially decreased maximum urinary flow rate. Other urodynamic studies showed no statistical differences. The groups did not differ significantly with respect to intraoperative complications or objective and subjective cure rates. Operating time was significantly longer for laparoscopic Burch (p = 0.001), and three patients in that group required conversion to laparotomy. Length of hospital stay (p = 0.003) and duration of catheterization (p = 0.003) were shorter in the TVT group. CONCLUSION: TVT holds promise in women with genuine stress incontinence, with several advantages over laparoscopic Burch.     

The use of general anesthesia for the tension-free vaginal tape procedure and concomitant surgery

BACKGROUND: To study the efficacy of performing the TVT procedure and concomitant surgery under general anesthesia in the management of urinary stress incontinent patients. METHODS: Eighty-six women with genuine stress incontinence without pelvic relaxation syndrome were surgically managed. TVT procedures were performed using vigorous manual pressure against the abdominal wall to position and adjust the vaginal tape and ensuring no lifting of the urethra by intraoperative introital ultrasonography. Concurrent gynecologic procedures were performed, if indicated. The urodynamic studies, 1-h pad-tests and introital ultrasonography were performed preoperative and 1 year after surgery. RESULT: Six women were excluded for various reasons. Among 80 patients, 74 (92.5%) were cured, five improved and one failed. No major intra-or postoperative complications occurred. After surgery, urine leakage observed on the pad-tests was significantly reduced from a mean of 24 to 1.3 g. The operating time for the TVT procedure was 23 min, and postoperative hospital stay was 2.8 days. The position and mobility of the bladder neck showed no significant difference before and after surgery. De nova detrusor instability was observed in one patient. Spontaneous voiding with adequate volume of post-void residual urine was noted for all patients by the fourth day postoperatively. Urodynamic parameters related to the voiding dysfunction showed no significant difference pre- and postoperatively. CONCLUSION: With modifications of the technique and the aid of intraoperative ultrasonography, the TVT procedure can be performed under general anesthesia. The procedure is safe, effective, minimally invasive, and has an additional benefit of correcting various coexisting gynecologic disorders in a single operation.     

Lateral excision of tension-free vaginal tape for the treatment of iatrogenic urethral obstruction

OBJECTIVE: To report our experience on lateral excision of tape in women with iatrogenic urethral obstruction after the tension-free vaginal tape (TVT) procedure. METHODS: Seven women had iatrogenic urethral obstruction based on their clinical and urodynamic findings. All underwent lateral excision of the tape using the vaginal approach. Lower urinary tract symptoms, postvoid residual volume and urodynamic data were evaluated before and after excision. RESULTS: Before excision, all subjects had either irritative symptoms or increased postvoid residual volume (more than 100 mL), and 6 (85.7%) voided with strain. The mean time from initial surgery to tape excision was 28 days (range 4 to 108), with an average follow-up of 32 months (range 24-39). After the excision, voiding dysfunction was resolved in 6 of 7 patients. The remaining patient had significant improvement with only occasional symptoms of irritation. Two (28.6%) women reported recurrent stress incontinence and 1 (14.3%) required surgical treatment. The intervals for the 2 recurrent patients from TVT to excision were 4 days. The intervals for the 5 continent women were 15 to 108 days. CONCLUSION: Urethral obstruction after TVT is a relatively uncommon condition. It can be effectively treated with transvaginal lateral excision of the tape. Recurrent stress incontinence seems to be less likely to occur when the takedown procedure occurs beyond 14 days after the initial TVT operation.     

阴道无张力尿道中段悬吊术治疗女性尿失禁的临床观察

目的　探讨阴道无张力尿道中段悬吊术 (tension freevaginaltape ,TVT)治疗女性尿失禁的临床效果。方法　回顾性分析自 2 0 0 1年 5月至 2 0 0 3年 2月 ,应用TVT手术治疗的 2 3例 (其中18例为压力性尿失禁 ,5例为混合性尿失禁 )女性尿失禁患者的临床资料。结果　 2 3例TVT手术中 ,除 1例因术中可疑有损伤而改为尿道折叠 (Kelly)术外 ,其余TVT手术均成功 ,手术成功率为96 % (2 2 / 2 3)。 2 0例 (91% )术后排尿功能恢复良好 ,2例 (9% )分别因膀胱不稳定 (运动型急迫性尿失禁 )及感染而发生排尿困难 ,经持续导尿、膀胱训练及药物治疗后 ,均恢复正常排尿功能。平均手术时间为 4 9min。术后两年随访所有患者 ,排尿功能均恢复正常。结论　TVT手术简单、微创、恢复快、效果好。     

Results of tension-free vaginal tape in patients with or without vaginal hysterectomy

OBJECTIVE: To assess complications and cure rates of tension-free vaginal tape (TVT) procedure performed with or without vaginal hysterectomy. STUDY DESIGN: Retrospective comparison of 41 women with urinary incontinence treated by a TVT procedure alone and 40 combined with vaginal hysterectomy. Objective cure was evaluated by clinical and urodynamic examination and by the contilife questionnaire. All patients were operated under regional anesthesia. RESULTS: The two groups were similar in age, parity, menopausal status and type and severity of incontinence. There was no difference in overall complication rates. In the TVT-hysterectomy group, there was a trend towards more bladder perforation (P=0.09). Post-operative urinary flow was lower in the TVT-hysterectomy group: 14 versus 24 ml/pc (P=0.02). The mean follow-up was similar: 23 and 25 months, respectively. No difference in objective and subjective cure rates was found between TVT group and TVT-hysterectomy group: 97.6% versus 92.5% and 68.3% versus 75%, respectively. CONCLUSION: TVT is a safe and effective surgical treatment of urinary incontinence. The association of the procedure with vaginal hysterectomy gave similar short-term objective and subjective cure rates than TVT technique alone.     

Results of the tension-free vaginal tape procedure for treatment of female stress urinary ıncontinence: a 5-year follow-up study

Objective  We evaluated the long-term cure rates, surgical complications rates after treatment of urodynamically confirrmed primary genuine stress incontinence with tension-free vaginal tape (TVT). Methods  We performed a retrospective review of all patients undergoing the TVT procedure over a 5-year period to report intraoperative complication, postoperative complications and subjective cure rates. Results  TVT was performed on 600 patients under general anesthesia. Among these patients, 563 were followed up for least 5 years; the remaining 47 patients could not be followed up. The mean follow-up interval was 63.1 ± 3.1 (range 60–70) months. The mean age of the women was 51.7 ± 11.6 years and mean body mass index 31.7 ± 3.0 kg/m². Sixty-two percent (347) of women underwent the TVT procedure in conjunction with other vaginal surgery, and 38% (216) underwent TVT alone. The subjective analysis of the effect of surgery on the symptom of GSI was that, overall, 86.7% were completely cured, 6.0% were significantly improved and 7.3% found no change in the severity of her incontinence. No major nerve or vessel injury occurred, but 17 patients (3.0%) incurred bladder injury during the surgery. De novo voiding urgency occurred in 36 patients (6.4%). Thirty patients (5.3%) developed voiding problem, of which 19 patients had short-term voiding problem. Conclusion  The TVT procedure is a relatively safe and effective, minimally invasive surgical technique for the treatment of female urinary stress incontinence.     

Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence--a long-term follow-up

BACKGROUND: To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence. METHOD: A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2-8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency. RESULTS: Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p=0.01), parity (2.6 versus 2.3; p=0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population. CONCLUSION: Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence.     

Incomplete bladder emptying after the tension-free vaginal tape procedure,necessitating release of the mesh. A report of three cases

BACKGROUND: The Tension Free Vaginal Tape (TVT) (Ethicon, Inc., Somerville, New Jersey) procedure is a minimally invasive surgical treatment for stress urinary incontinence. Urinary retention is a potential complication that may require release of the tape. CASES: In three cases, prolonged urinary retention occurred after the TVT procedure. Two of the three cases were performed in conjunction with anterior repair. All three patients required surgical release of the tape, which was located at the urethrovesical junction rather than midurethra. All three patients remained stress continent after tape release. One patient developed urge incontinence. CONCLUSION: Excessive tension, as well as tape migration toward the urethrovesical junction, may be the cause of prolonged urinary retention after the TVT procedure. Surgical release of the tape is an effective management approach to this complication.     

不同路径阴道无张力尿道中段悬吊术治疗重度压力性尿失禁

目的 探讨经耻骨后路径阴道无张力尿道中段悬吊(TVT)术及经闭孔路径阴道无张力尿道中段悬吊(TVT-O)术治疗女性重度压力性尿失禁的临床效果.方法 前瞻性随机对照单盲方法选取重度压力性尿失禁患者69例(其中35例行TVT,34例行TVT-O),部分患者合并Ⅰ～Ⅱ度子宫脱垂及阴道前壁膨出.分别记录两种路径手术的手术时间、术中出血量、术后住院时间、住院费用,以及术中、术后并发症的类型和发生率.运用尿道疾病程度分类问卷(UDI-6)和尿失禁相关生活质量问卷(ⅡQ-7)对两组患者组内及组间手术前后生活质量的变化进行评估.结果 TVT-O组平均手术时间为(18±5)min,明显短于TVT组的(27±5)min,差异有统计学意义(P＜0.01).两组术中出血量、术后第1天B超测量残余尿量的合格率、并发症发生率、术后住院时间和住院费用均相似,差异均无统计学意义(P均＞0.05).术后随访率100%,平均随访时间14.5个月.TVT组治愈率88.6%(31/35),略高于TVT-O组[85.3%(29/34)],但两组间比较,差异无统计学意义(P＞0.05).吊带侵蚀发生率TVT组为5.7%(2/35),高于TVT-O组[2.9%(1/34)];耻骨上、腹股沟或大腿内侧酸痛发生率TVT组为5.7%(2/35),低于TVT-O组[14.7%(5/34)],但差异均无统计学意义(P均＞0.05).两组间手术前后UDI-6和ⅡQ-7问卷各项目评分及总体评分分别比较,差异均无统计学意义(P均＞0.05).两组内手术后UDI-6问卷(除梗阻项目)和ⅡQ-7问卷各项目评分及总体评分较手术前均明显降低,差异均有统计学意义(P均＜0.01),UDI-6问卷中梗阻项目评分,两组内手术前后比较,差异无统计学意义(P＞0.05).结论 TVT-O路径较TVT路径手术时间短,术后短期随访结果显示,两种手术路径均可有效治疗重度压力性尿失禁、改善患者生活质量且不增加尿道梗阻风险,但长期疗效有待进一步随访观察.     

A three-year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence.

OBJECTIVE: To study the long term results of tension-free vaginal tape, a new ambulatory surgical procedure for treatment of female stress urinary incontinence. STUDY DESIGN: A prospective open study using a standardised protocol for pre- and post-operative evaluation. PARTICIPANTS: Fifty consecutive women participated in the study. All suffered from genuine stress incontinence. The mean age was 57 years (SD 11), 42 women (84%) were multiparous, 8 (16%) nulliparous. SURGICAL METHOD: Tension-free vaginal tape implies the implantation of a prolene tape around mid-urethra via a minimal vaginal incision. The procedure is carried out under local anaesthesia, allowing the surgeon to check intra-operatively that continence has been obtained. RESULTS: All the women except one could be operated on an ambulatory basis under local anaesthesia. Mean operation time was 29 minutes (range 1647). Ninety percent of the women were able to micturate spontaneously within 24 hours with insignificant residual volumes. In another 10% of the women an in-dwelling catheter had to be used temporarily. There was no need for long term postoperative catheterisation (> 14 days). Post-operative evaluation was carried out after 2 to 6, 12, 24 and 36 months. According to the protocol, 86% of the women were completely cured and another 11% were significantly improved. No signs of deterioration of the results over time were observed. No defect in healing or rejection of the tape occurred. CONCLUSION: We consider the tension-free vaginal tape operation to be a safe and effective surgical procedure for the treatment of female urinary stress incontinence. The technique can be considered as an ambulatory procedure performed under local anaesthesia, allowing the majority of the women to be discharged from the clinic the same day or the day after the procedure.