Monarc vs TVT-O for the treatment of primary stress incontinence: a randomized study

The aim of the study was to compare the efficacy and complications of the Transobturator tape (Monarc) vs the tension-free vaginal tape obturator (TVT-O) in women with urodynamic stress incontinence. A prospective, randomized study was conducted. One-hundred and twenty patients were included in the study, and 114 of them were available at 12 months follow-up. Sixty-one patients were subjected to the TVT-O procedure and 53 to the Monarc procedure. Subjective and objective cure and improvement rate and complications incidence were assessed. The objective cure rate was 87% for the TVT-O procedure and 90% for the Monarc group. The subjective cure rate was 80% for the TVT-O group and 77% for the Monarc group. The improvement was 13 and 11.5% for the TVT-O and Monarc groups, respectively. There was one accidental injury to the urethra with the Monarc technique. The Monarc technique presents success rates and complications comparable to the TVT-O method at 1 year follow-up.     

TVT vs Monarc: a comparative study

Following the success of the tension-free vaginal tape (TVT), there has been considerable interest in technique modifications such as the transobturator approach for implant placement. We attempted to elucidate possible anatomical and clinical differences between the two methods in a retrospective cohort study. One hundred and fourteen women who had undergone TVT or Monarc implantation were assessed by or under the supervision of the senior author, with identical tensioning technique. They were followed up by an interview, uroflowmetry, and translabial 3D ultrasound. There were significant differences for patient satisfaction (P=0.013), subjective overall cure/improvement (P=0.0018), and the symptom of poor stream (P=0.03), all favoring the Monarc group. On imaging Monarc tapes appeared more proximal at rest (P=0.006) and Valsalva (P=0.002) and remained further from the symphysis pubis on Valsalva (P=0.01). At 9 months follow-up, there was no significant difference as regards to cure rates for stress incontinence between the two suburethral slings. Monarc tapes are located more proximally and may be less obstructive, judging from a lower incidence of symptoms of voiding dysfunction. Patient satisfaction and overall subjective cure/improvement were higher after Monarc. In summary, the Monarc is an effective TVT alternative, achieving cure of stress incontinence by similar means. It may be less obstructive, resulting in improved patient satisfaction.     

TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence

TVT-O and TVT were compared in patients stratified according the severity of Stress Urinary Incontinence (SUI). Those patients with intrinsic sphincter deficiencies, overactive bladders, associated prolapses, neurovegetative disorders and recurrent SUI or under rehabilitative/medical therapies were all excluded. There were 208 women included. Operating times were longer, and postoperative pain greater for TVT (p < 0.001). TVT produced longer hospitalizations in severe SUI patients (p < 0.001). After 1 year of follow-up, incontinence was cured in all mild SUI patients with both techniques, in all severe SUI patients when treated with TVT and in 66% of them when treated with TVT-O (p < 0.001). Vaginal perforations occurred during the TVT-O (p = 0.01), bladder perforations during TVT (p = NS), bladder obstructions in mild SUI patients after TVT (p < 0.001). The severity of SUI is an important parameter that influences results after TVT-O and TVT, and could be used to guide surgeons in selecting the most effective intervention.     

TVT and TVT-O for surgical treatment of primary stress urinary incontinence: prospective randomized trial

Introduction and hypothesis  

A study was conducted to compare the efficacy and complications of TVT and TVT-O.     

A randomized trial comparing TVT with TVT-O: 12-month results

The aim of this randomized clinical trial was to compare the cure rate and the rate of complications of the tension-free vaginal tape (TVT) with those of the tension free vaginal tape obturator (TVT-O) procedure after one year of follow-up. The study was powered to show a ten per cent difference in cure rate and/or rate of complications. Of the initially treated 267 women 134 in the TVT group and 131 in the TVT-O group were evaluated. A cough stress test and a 24 h pad test were used as objective outcome measures. Subjective outcome was assessed by different condition-specific quality of life questionnaires and general health by the EQ-5D questionnaire. Objective cure rate was 95.5% in the TVT patients and 93.1% in TVT-O patients. Subjective cure rates showed significant improvement at one the year follow up in both groups. No significant differences in cure rates between groups were seen. The complication rate was equal in both groups.     

Peri-operative morbidity and early results of a randomised trial comparing TVT and TVT-O

The aim of this study was to compare the morbidity and short-term efficacy of retro-pubic (TVT) and inside-out trans-obturator (TVT-O) sub-urethral sling in the treatment of stress urinary incontinence. This was a prospective multi-centre randomised trial; 231 women with primary stress urinary incontinence were randomised to TVT (114) or TVT-O (117). The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS) and Patient Global Impression of Severity (PGI-S) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure the patient’s perception of incontinence severity. The primary and secondary outcome measures were rates of success and complications. The SPSS software was used for data analysis. The TVT-O procedure was associated with significantly shorter operation time and with a more extensive use of general anaesthesia when compared with TVT. There were 5 (4%) bladder perforations in the TVT group compared with none in the TVT-O group. Rates of early post-operative urinary retention and voiding difficulty were similar for both groups and no difference was found in the average hospital stay. Six patients (5%) in the TVT-O group complained of thigh pain in the post-operative course. The median follow-up time was 6 months. Two hundred eighteen patients were available for the analysis of outcomes. Subjective and objective cure rates were 92% and 92% in the TVT group and 87% and 89% in the TVT-O group. The ICIQ-SF questionnaire symptoms score showed a highly statistical decrease in both groups, the W-IPSS on the contrary was unchanged. Our data show that both procedures were equally effective in the short-term for the treatment of stress urinary incontinence with a highly significant improvement in incontinence-related QoL.     

TVT-O手术与 A-JUST手术治疗女性压力性尿失禁的临床疗效研究

目的:探讨TVT-O手术和A-JUST手术治疗女性压力性尿失禁(SUI)的临床疗效,为女性SUI的临床手术方案选择提供参考依据。方法:选取2014年5月—2016年12月在我院确诊为SUI的女性患者157例,随机分为两组:TVT-O组(80例)和A-JUST组(77例),对两组患者的一般资料、手术效果、术后生活质量和并发症进行统计分析。结果:两组患者手术时间和术中出血量比较,均无统计学差异(P>0.05)。与TVT-O组相比,A-JUST组住院天数、留置尿管时间和大腿内侧牵扯痛发生率明显要少,差异均有统计学意义(P<0.05)。两组患者术后I-QOL评分均逐渐提高,但同期得分相比无统计学差异(P>0.05)。两组患者手术后治愈率和改善率均无统计学差异(P>0.05)。两组患者远期并发症主要是排尿困难、漏尿和尿潴留,但发生率均无统计学差异(P>0.05)。结论:A-JUST术与TVT-O术治疗女性SUI均有良好的临床疗效。A-JUST术具有住院时间短、导尿时间和术后大腿内侧牵扯痛率低的优势,值得临床推广。     

TVT compared with TVT-O and TOT: results from the Norwegian National Incontinence Registry

Introduction and hypothesis  

The aim of this study is to compare the outcome and complication rates of the tension-free vaginal tape (TVT) operations with the transobturator vaginal tape (TVT-O and TOT) operations in the treatment of urinary stress incontinence.     

Avaulta solo~(TM)骨盆底修复系统联合TVT-O治疗阴道前壁脱垂合并压力性尿失禁的临床研究

目的:观察Avaulta soloTM骨盆底修复系统联合经闭孔经阴道无张力尿道中段悬吊术(TVT-O)治疗盆腔器官脱垂(POP)合并压力性尿失禁(SUI)的临床效果。方法:2011年1月~2012年2月我院收治阴道前壁脱垂合并SUI患者28例,同期行Avaulta骨盆底修复和TVT-O。术后定期随访,以盆腔脏器定量分度法(POP-Q)作为客观疗效评价指标,以盆腔器官脱垂/尿失禁性功能问卷(PISQ-12),盆底功能障碍影响问卷简版(PFIQ-7),盆底困扰量表简表(PFDI-20)作为主观治愈指标。结果:28例患者手术均顺利完成,手术时间(116.1±23.6)min,估计手术出血量为(83.9±54.4)ml,术后平均住院时间为(6.6±3.1)d。客观治愈率92.9%。随访24~36个月,平均25.7个月,术后2年主观评价量表各项与术前比较,差异有统计学意义(P0.05)。2例(7.1%)手术失败患者中1例术后仍有明显压力性尿失禁,另1例术后1周左右出现阴道前壁脱垂。另外有1例(3.6%)复发SUI。结论:Avaulta骨盆底修复系统同期联合TVT-O治疗阴道前壁脱垂合并SUI短期疗效确切,简便微创。     

TVT-O for the treatment of female stress urinary incontinence: results of a prospective study after a 3-year minimum follow-up

OBJECTIVES: Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown. We analyzed the 3-yr results of a prospective, observational study designed to evaluate the safety and efficacy of the TVT-O procedure. METHODS: Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual (PVR) measurement, and urinary symptoms and quality of life (QoL) questionnaires. Data were compared by means of the Wilcoxon matched pairs test. RESULTS: Between March 2003 and December 2003, 102 consecutive patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria underwent the TVT-O procedure; the latter was associated with pelvic organ prolapse treatment in 16 patients (15.7%). Three-year minimum follow-up (median, 40 mo) was available for 91 patients (89.2%). No erosion or persistent pain was noted. Four patients required tape release or section. Disappearance and improvement of SUI were observed in 88.4% and 9.3% of the patients, respectively. These cure rates were similar to those obtained 1 yr after the operation (p=0.55). Frequency and urge symptoms were improved at 3 yr (p<0.005). Whereas maximum flow rates were somewhat decreased (p=0.01), the severity of obstructive symptoms and PVR volumes were not statistically different (p=0.11 and p=0.32, respectively). Incontinence severity and QoL scale scores were largely better than preoperative ones (p<0.001) and did not differ from those reported at 1 yr (p=0.15 and p=0.08, respectively). CONCLUSIONS: The TVT-O procedure is a safe and efficient treatment of female SUI, with maintenance of high cure rates after a 3-yr minimum follow-up.     

Long-term outcomes of TVT and IVS operations for treatment of female stress urinary incontinence: monofilament vs. multifilament polypropylene tape

Introduction and hypothesis  We compared cure rates of tension-free vaginal tape (TVT) with intravaginal slingplasty (IVS) and evaluated changes in cure rates over time. Methods  One hundred three underwent TVT and 213 underwent IVS. Follow-ups were done at 3 months, 1 year, and 5 years. Results  The following results were found: objective cure for TVT 98–95–94% vs. IVS 86–86–80% (p < 0.03); subjective cure for TVT 82–79–74% vs. IVS 79–81–71% (NS). In IVS, a significant decline in subjective cure took place. Vaginal erosions were found in 11.8% of women in the IVS group and none in the TVT group. Conclusions  TVT is an effective and stable treatment, whereas IVS has a significant inferior objective cure rate, and a significant decline in subjective cure rate occurred over time. A high rate of vaginal erosions was found in the IVS group. We cannot recommend the use of multifilament polypropylene tape (IVS) for surgical treatment of stress urinary incontinence.     

Randomized trial of porcine dermal sling (Pelvicol implant) vs. tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence: a questionnaire-based study.

The objective of this study was to compare porcine dermal sling (Pelvicol implant, Bard) with tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence. One hundred and forty-two women with genuine stress incontinence (GSI) were randomly assigned to either Pelvicol implant pubovaginal sling (n=74) or TVT (n=68). They were followed up at a minimum of 6 months (range 6-24 months), with a median follow-up of 12 months. The majority (n=109) of procedures were carried out in a day surgery unit. The median operation time was 35 minutes (range 15-60) in the TVT group and 30 minutes (range 20-80) in the Pelvicol implant group; 81% of the TVT group and 77% of the Pelvicol implant group were able to void urine within 24 hours, and had insignificant residual bladder volumes. The prevalence of postoperative symptomatic voiding dysfunction was 3.4% after TVT and 1.4% after Pelvicol implant. Nine percent of the TVT group developed de novo urge incontinence and 6% of the Pelvicol implant group had de novo urge incontinence 6 months after the procedure. Postoperative evaluation was done at the outpatient department, and a postal questionnaire was also completed to determine subjective continence status. The patient-determined cure rate was 85% in the TVT group and 89% in the Pelvicol implant group. The Pelvicol implant sling had a comparable patient- determined success rate with TVT and should be considered in the surgical treatment of women with genuine stress incontinence.     

TVT vs TOT: a case controlled study in patients with mixed urodynamic stress incontinence and detrusor overactivity

Introduction  

Although transobturator tapes (TOT) have been suggested to be equivalent to retropubic tension-free vaginal tapes (TVT) in the management of urodynamic stress incontinence, there is very little evidence for their use in women with mixed incontinence. The aim of this study was to evaluate the efficacy of the TOT against the retropubic TVT in women with mixed incontinence.     

TVT-O治疗女性压力性尿失禁的远期疗效和尿动力学分析

目的 评估经闭孔无张力尿道中段悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的远期疗效、并发症及尿动力学情况. 方法 回顾性分析2007年5月至2011年6月24例TVT-O治疗女性SUI患者的临床资料,术后远期随访尿动力学检查、生活质量评分和并发症情况. 结果 患者术后12 ～ 60个月回院完成远期随访.术后远期主观成功21例(87.5％),客观成功22例(91.7％),满意23例(95.8％),生活质量评分(20.0±2.4)分.术前腹压漏尿点压为(56.6±20.1)cm H2O(1 cm H2O=0.098 kPa),术后远期23例＞100 cm H2O,1例为66 cm H2O,其余尿动力学参数与术前比较差异无统计学意义(P＞0.05).远期并发症以排尿费力(8例)和外界反射性尿意(4例)多见.结论 TVT-O具有操作简便快捷、微创、安全、有效、并发症少的优点,长期随访对于全面评价TVT-O术式远期并发症和疗效持久性有重要意义,术后尿动力学检查对于评价手术疗效和并发症有较大价值.