Sequential assessment of urodynamic findings before and after transobturator tape procedure for female urodynamic stress incontinence

The objective of this study was to sequentially compare the urodynamic findings of patients with urodynamic stress incontinence before and after transobturator tape procedure. Between May 2004 and December 2005, 26 of 34 consecutive patients with urodynamic stress incontinence who underwent transobturator tape procedure were enrolled. The sequential urodynamic findings of each case were compared and analyzed. Based on pad test, the cure and improvement rates were 69.2 and 30.8%, respectively. A significant increase in pressure transmission ratio at maximal urethral pressure at 1 year postoperatively (p = 0.005) was observed after surgery. The improvement group (n = 8) had significantly lower preoperative maximal urethral closure pressure (45.4 vs 68.2 mmHg, p = 0.036) than did the cure group (n = 18). The postoperatively increased pressure transmission ratio at maximal urethral pressure appears to contribute to its cure for urodynamic stress incontinence.     

Long-term subjective results of tension-free vaginal tape operation for female urinary stress incontinence

Introduction and hypothesis  

The aim of the study was to evaluate the subjective outcome between 1 and 5 years after tension-free vaginal tape (TVT) operation and the need for follow-up.     

Sexual function after tension-free vaginal tape (TVT) for stress incontinence: results of a mailed questionnaire

In a retrospective study we evaluated sexual function after tension-free vaginal tape (TVT) placement for urinary stress incontinence based on responses to a mailed questionnaire at least 3 months after the operation, to a maximum of 1 year. From 1999 to 2002, a sexual function questionnaire was mailed to 128 women (and their partners) who had undergone a TVT procedure for genuine urinary stress incontinence, without pelvic organ prolapse or detrusor instability. The questionnaire was returned by 96 women (75%), 69 (72%) of whom reported being sexually active. Mean frequency of intercourse did not change. Overall, 26% described improved intercourse compared to before the operation. Only one patient described worsening of intercourse after the TVT operation because of an increase in her incontinence. Overall, in this study the technique of tension-free vaginal tape as such seems to have no negative impact on sexual function. However, because of its successful outcome on incontinence, it has a positive overall effect on sexual function. The possible causes of postoperative partner discomfort require further investigation.Abbreviations AVWS Anterior vaginal wall suspension - SUI Stress urinary incontinence - TVT Tension-free vaginal tape This study was supported by the Pelvic Floor & Sexuality research group Leiden. Editorial Comment: The impact of urogynecologic surgery on sexual function is unclear. For those who are incontinent with intercourse, cure of incontinence may improve sexual activity at the price of potential damage to the vaginal anatomy. In this study sexual function following the TVT procedure was evaluated. The authors report that sexual frequency was overall unchanged, and many patients felt that intercourse improved. It appears that much of this improvement is probably related to cure of the incontinence rather than any specific features of the TVT. Although the study is flawed by its retrospective design and a long interval between the procedure and the questionnaire, the results overall are reassuring.     

经阴道无张力吊带术治疗女性压力性尿失禁的体会

目的探讨经阴道无张力吊带术(TVT)治疗女性压力性尿失禁(SUI)的疗效及安全性。方法对2002年5月至2004年12月施行TVT的114例女性SUI患者资料进行回顾性研究。根据Stamey尿失禁分级系统评价TVT手术的有效性。术后较术前尿失禁等级评分改善2级或2级以上为显著改善,1级为改善,无改善甚至加重为无效。术后尿失禁等级为0~1级为完全控尿,2级为有效控尿,3~4级为无效。评估术前、术后的24h尿垫试验及尿动力学检查结果。并对并发症进行统计和分析。结果随访110例(96.5%),随访时间6~30个月。24h尿垫试验术前(38.3±10.4)g,术后(8.8±7.4)g;尿失禁症状评分从术前42.3±11.4,术后20.4±9.2;尿失禁等级评分显著改善者94例(85.5%),改善者12例(10.9%),无效者4例(3.6%)。术后完全控尿者89例(80.9%),有效控尿者14例(12.7%),无效者7例(6.4%)。术中发生膀胱穿孔2例(1.8%),出血14例(12.7%)。术后1个月内有排尿不畅者9例(8.2%),尿频、尿急者12例(10.9%),尿潴留者1例(0.9%);术后6个月后有耻骨上不适者8例(7.3%),排尿不尽者2例(1.8%),尿频、尿急者3例(2.7%)。1例反复尿潴留患者经保守治疗无效,最终将吊带切断。术后未出现吊带处阴道黏膜糜烂和明显盆腔血肿。结论TVT术是目前治疗女性SUI的一种有效、安全的微创手术。     

Quality of life after tension-free vaginal tape surgery for female stress incontinence

OBJECTIVE: To undertake a long-term follow-up evaluation of the quality of life (QOL) of women who had undergone a tension-free vaginal tape (TVT) procedure. MATERIAL AND METHODS: During the period 1995-2001, 970 women with urinary stress incontinence underwent TVT surgery at the Department of Obstetrics and Gynecology, Falun Hospital. A questionnaire was mailed on average 5.7 years after the TVT procedure. Two incontinence-specific QOL instruments--the Incontinence Impact Questionnaire-7 (IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6)--were administered. An additional questionnaire included general questions and questions about chronic diseases that may be associated with urinary incontinence. RESULTS: The mean age at surgery was 58.7 years (range 29-89 years). Of 913 eligible women, 768 (78.9%) responded. Mean IIQ-7 and IDU-6 scores as estimated by the women improved dramatically at follow-up as compared to preoperative values: from 43.7 to 11.5 for the IIQ-7 and from 54.2 to 24.0 for the UDI-6 on a scale from 0 to 100 (p = 0.0001 for both). There were few differences in mean QOL scores even 8 years after TVT surgery, compared to those determined a shorter time after the operation. Women with diabetes, chronic constipation, chronic bronchitis and preoperative recurrent urinary infections had a relative improvement in QOL of the same magnitude as that of the remaining study population. Advanced age was negatively associated with an improvement in QOL scores. CONCLUSIONS: Improvements in measures of QOL after TVT surgery are dramatic and persist for years. Women with concomitant diseases that may be associated with urinary incontinence can be assured that there is a good chance of success with TVT surgery.     

Sexual function after using tension-free vaginal tape for the surgical treatment of genuine stress incontinence

OBJECTIVE: To determine whether the use of the tension-free vaginal polypropylene tape (TVT) procedure for the treatment of genuine stress incontinence (GSI) affects sexual activity. PATIENTS AND METHODS: Sixty-seven women treated by insertion of a TVT between September 1998 and March 2001 for GSI were sent questionnaires 6-36 months after surgery to determine any urinary symptoms, sexual activity, patient satisfaction and the use of hormone-replacement therapy. RESULTS: The questionnaire was returned by 57 patients (87%); 43 (76%) reported being sexually active and 14 (25%) were not. Of the former, 31 (72%) reported no change in sexual function after surgery and only two reported an improvement; six (14%) reported that sexual function was worse and four did not reply to the questions. The patients reporting that sexual function was worse cited loss of libido as the main reason. No patients complained of dyspareunia. CONCLUSIONS: There was no significant change in sexual function or activity after the TVT procedure and patients can thus be reassured that this operation will not affect their sex life.     

Necrotizing fasciitis after tension-free vaginal tape (TVT) placement

A 62-year-old homemaker underwent an uneventful TVT (tension-free vaginal tape) procedure. Eleven days postoperatively she presented to the Emergency Department with agonizing low abdominal pain, elbow pain, fever, and drainage from her suprapubic puncture sites. Her evaluation was consistent with a diagnosis of necrotizing fasciitis and she was started on antibiotics and taken to surgery for exploration and debridement, where the diagnosis was confirmed. This is the first report of necrotizing fasciitis following TVT placement.     

The tension-free vaginal tape procedure for female urinary incontinence without preoperative urodynamic evaluation

BACKGROUND: We evaluated the short-term outcomes of the tension-free vaginal tape (TVT) technique for female urinary incontinence, when the diagnosis was based on incontinence symptoms and pelvic examination including cough stress test or transperineal ultrasonography or both, but without preoperative urodynamic verification. STUDY DESIGN: Tension-free vaginal tape was performed on 191 patients under local (82%) or spinal (18%) anesthesia. One hundred twenty-seven women (66%) had stress urinary incontinence and 64 (34%) had mixed incontinence. Fifty-eight percent had undergone previous surgery; 21% for incontinence. Thirty-four women underwent concomitant surgery. The age range was from 32 to 84 years (mean 60) and parity from 0 to 8 (mean 2). Seventy-four (39%) had concomitant chronic illnesses. The diagnosis of incontinence was based on specific questionnaires and physical examinations. Urogynecological ultrasonography was performed on patients with mixed incontinence. The mean followup was 17 months. RESULTS: The mean operative time was 27 min (16 to 63), the mean hospital stay was 2 days (1 to 10). Intraoperative complications were: bladder perforation in five patients (2.6%), hematoma in five patients (2.6%), heavy bleeding (400 mL) in one patient, and persistent retention in four patients (2.2%). Altogether, 164 of 187 patients (87.7%) were completely cured, and 23 patients experienced no improvement. Six patients (4.8%) developed de novo urge incontinence, 60% had less urge incontinence. The cure rates were: 97% among stress urinary incontinence patients versus 69% among mixed incontinence patients (p = 0.001); TVT alone, 88% versus in combination with other surgery 85% (p = 0.576); TVT under local anesthesia, 88% versus under spinal anesthesia 88%; TVT with recurrent incontinence, 85% versus primary incontinence 89% (p = 0.583); and in patients with concomitant illnesses, 82% versus healthy 91% (p = 0.076). CONCLUSIONS: Tension-free vaginal tape can be used to treat patients with primary or recurrent stress or mixed incontinence with or without concomitant surgery under local or spinal anesthesia. But the success rate is considerably lower in patients in whom TVT is performed for mixed incontinence.     

A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence

The aim of the study was to evaluate the safety and efficacy of TVT (tension-free vaginal tape) for the surgical treatment of stress urinary incontinence. The design was a prospective open multicenter study including six centers, each operating an approximately 20 patients. In total 131 patients suffering from genuine stress incontinence were included. They were followed for at least 1 year using a specific protocol for objective and subjective evaluation of the outcome. All patients underwent the operation under local anesthesia. Mean operation time was 28 minutes (range 19–41 minutes); 119 (91%) of the patients were cured according to the protocol and another 9 (7%) were significantly improved. There were 3 (2%) failures. The majority of the patients (about 90%) were operated upon on a day-care basis, which implied that they were released from the hospital within 24 hours, with no postoperative catheterization. No defect healing and no tape rejection occurred. Three patients needed an indwelling catheter for 3 days. In 1 patient catheterization was necessary for more than 10 days. Two uncomplicated hematomas and one uncomplicated bladder perforation occurred. Based on the results, we conclude that TVT is a safe and effective ambulatory procedure for surgical treatment of genuine stress urinary incontinence.Editorial Comment: This is the first prospective study of a relatively new and minimally invasive surgical procedure for stress urinary incontinence. The authors are to be complimented on the fact that they went out into the community hospitals in their area to see if their results could be reproduced by the average practicing gynecologist. Also, it is good to see that the investigators used a validated quality of life assessment to provide very important follow-up information on the improvement in the patient's quality of life, as this should be the basic tenet of all therapies for urinary incontinence. However, many questions remain regarding the diagnostic criteria they used in selecting their patients, as well as the degree of testing performed postoperatively. Further study is needed to confirm the results found here with a very new and interesting technique in the surgical treatment of stress incontinence.     

Fulfilment of patient goals after tension-free vaginal tape operation for stress urinary incontinence

Introduction and hypothesis

The aim of this study was to investigate patient-reported goals after a tension-free vaginal tape operation for stress urinary incontinence and the correlation with postoperative incontinence.

Methods

A prospective study involving 70 women was carried out. Preoperatively, patients completed the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and stated three goals for the operation. A telephone interview was performed 3 months postoperatively.

Results

A Visual Analogue Scale (VAS) score from zero to ten estimated the extent to which goals were achieved. Goals were divided into five groups: 1, symptoms; 2, quality of life (physical); 3, quality of life (emotional); 4, sexual function; 5, avoidance. ICIQ-UI SF preoperative mean was 14.9 and postoperative mean was 1.5 (p?<?0.05). A total of 210 goals were stated. The majority of the goals (38 %) were in group 2 concerning quality of life in the physical domains. Mean VAS score for all goals was 9.1 (SD 2). Thirty-seven patients (53 %) fulfilled all their goals. Twenty-one patients (30 %) did not have a VAS score of 10, although continent with an ICIQ-UI SF score of zero. Reasons for not achieving a full VAS score were that some still used pads out of fear (n?=?10), that their mental focus was still on incontinence (n?=?7) or that they had not yet tried some of the physical aims (n?=?7).

Conclusions

Most patients achieved their goals. The majority of the goals concerned quality of life in the physical domains.

     

无张力性吊带术治疗女性压力性尿失禁

目的探讨无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法13例经尿动力学检查证实为压力性尿失禁在连续硬膜外麻醉下经阴道前壁行无张力阴道吊带术，低平截石位，经阴道前壁向上穿刺尿道两侧间隙，从耻骨上腹壁引出TVT吊带，调整张力，关闭切口。结果手术时间15～45min，平均35min。13例随访6～24个月，平均13个月，12例治愈，1例改善，无尿失禁复发或排尿困难。结论TVT操作简单，创伤小，手术时间短，术后恢复快，治疗压力性尿失禁疗效好。     

Long-term follow-up of sexual function in women before and after tension-free vaginal tape operation for stress urinary incontinence

Introduction

This prospective study investigates sexual function in women after a tension-free vaginal tape (TVT) operation and compares short-term and long-term effects.

Methods

Sixty-three women had a TVT operation performed at Aalborg University Hospital, Department of Gynecology and Obstetrics, between November 2008 and June 2010. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 6 months postoperatively, and at the long-term follow-up (mean 4 years and 9 months).

Results

Forty-four women completed the two questionnaires all three times. Preoperatively, mean PISQ-12 was 33.8 [95% confidence interval (CI) 28.9-38.6] and the ICIQ-UI SF was 15.2 (14.4-16.0). Postoperatively the PISQ-12 increased significantly and the ICIQ-UI-SF decreased significantly, to 36.7 (31.5-41.9) and 2.5 (1.3-3.8), respectively, at the 6-months follow-up and 35.8 (33.6-38.1) and 4.9 (3.4-6.3), respectively, at the long-term follow-up. The greates improvement was in the physical domain of the PISQ-12. Women experienced less negative emotional reactions during intercourse, less coital incontinence, and less fear of being incontinent during intercourse after the TVT operation.

Conclusion

This study shows that a woman’s sex life does not deteriorate after a TVT operation, that their sexual function improves somewhat, and that results are sustained over time.

     

无张力阴道吊带术微创治疗女性压力性尿失禁

目的:评价无张力阴道吊带术(TVT)治疗女性压力性尿失禁的疗效。方法:对女性压力性尿失禁患者18例,经临床和尿动力学检查确诊,均为稳定性膀胱,无膀胱出口梗阻。采用TVT术,将吊带无张力置于尿道中段。结果:手术时间平均(40±6)min;术中出血量平均(43±11) ml;术后平均留置导尿1.5d;术后平均住院3d。18例患者术后尿失禁症状均消失。1例患者术后出现尿潴留,留置导尿1 周后好转,尿潴留症状消失,尿失禁未复发。结论:TVT手术因其简单,微创,疗效好,并发症少,目前可作为女性压力性尿失禁手术治疗的首选术式。     

TVT手术治疗女性压力性尿失禁的临床分析

目的探讨女性压力性尿失禁(SUI)的诊断及无张力阴道吊带术(TVT)的临床疗效。方法回顾性分析2003年5月至2004年8月我院16例女性压力性尿失禁患者无张力阴道吊带治疗效果、并发症情况。结果手术时间平均31.5min。术中出血平均62mL。随访1~15个月,全部病例均治愈,未见远期并发症。结论无张力阴道吊带术是治疗女性压力性尿失禁有效、安全、微创的方法,值得推广。     

Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases

Introduction: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity, good clinical results and rare complicationsMaterial and methodsFrom april, 1999 to march, 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10, 36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56,6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1% of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomyResultsWe obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient; 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization; one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy; one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures; and one patient presented pelvic discomfort with spontaneous resolutionConclusionsWe consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications.