The effect of tension-free vaginal tape (TVT) procedure on sexual function in women with stress urinary incontinence

The aim of this study was to evaluate the effects of tension-free vaginal tape (TVT) on sexual function in women with stress urinary incontinence (SUI) by questionnaire. Thirty-two sexually active and married women who were planned for TVT to treat SUI constituted the patient group, and 25 women who were healthy, sexually active and married, were selected as the control group; the ages of both groups matched. Sexual functions (desire, arousal, orgasm, pain and satisfaction) were evaluated with the Index of Female Sexual Function (IFSF), and continence status during sexual intercourse was asked about both preoperatively and postoperatively in the 6th month. The mean domain scores of sexual functions such as desire, arousal, orgasm, pain and overall satisfaction preoperatively and postoperatively were 3.37±0.69, 3.82±0.62, 3.40±0.95, 3.41±0.98, 3.16±1.09 and 3.32±0.79, 3.71±0.53, 3.06±1.04, 2.75±1.29, 2.88±0.63, respectively, and postoperative scores insignificantly decreased. Also, these scores in the control group were 3.64±0.66, 3.96±0.73, 4.12±0.78, 3.96±1.14 and 3.68±0.92. In comparison with the control group, whereas all of the preoperative domain scores were found to be decreased but were statistically insignificant except orgasmic function, postoperative scores significantly worsened, except for desire and arousal. However, preoperatively nine patients explained that they had incontinence during sexual intercourse, and this problem persisted in twopostoperatively (p = 0.043). This study shows that both SUI and the TVT procedure negatively affect sexual function in women.Abbreviations FSD Female sexual dysfunction - SUI Stress urinary incontinence - TVT Tension-free vaginal tape Editorial Comment: This study examines female sexual function in relation to SUI and the TVT procedure. The conclusion is that as a rule SUI negatively affects female sexual function. A successful TVT procedure does not improve patients perception of sexual function. Counseling for sexual dysfunction should therefore be part of the preoperative investigation.     

无张力阴道吊带修复女性压力性尿失禁

目的探讨无张力阴道吊带（tension—free vaginal tape，TVT）术的适应证、手术方法及并发症的预防。方法2003年9月～2004年12月共收治女性压力性尿失禁（stress urinary incontinence，SUI）患者40例，年龄30～73岁，平均56．3岁，病程1～42年，平均7．2年。其中伴膀胱或直肠膨出8例，子宫脱垂1例。均采用TVT术进行修复，对合并子宫脱垂或阴道前／后壁膨出者，一并行阴道前后壁部分剪除蝶形补片。结果40例患者术后均获满意效果，术后合并短时轻度排尿困难2例，膀胱穿孔及盆腔血肿各1例，经处理后均痊愈。患者均获随访1～15个月，无尿失禁复发及排尿困难。结论TVT术是一种治疗SUI的有效方法。     

Are there any factors predicting the cure and complication rates of tension-free vaginal tape?

Predictive factors that could possibly affect the cure and complication rates of tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) were investigated. Seventy-five consecutive patients with urodynamically proven SUI and who had undergone a TVT operation were evaluated according to a follow-up protocol. Median age was 51.2 (33–69). Thirteen (17%) of the patients had had previous anti-incontinence surgery. Sixteen (21%) patients had complained of pure stress and 59 (79%) of mixed incontinence. Valsalva leak point pressure (VLPP) values had been found to be below 60 cmH₂O in 36 (48%) and over 60 cmH₂O in 39 (52%) patients, while detrusor overactivity (DO) had been detected in six (8%) patients during urodynamic evaluation. Local, general, and epidural anesthesia had been performed in 43 (57%), 29 (39%), and three (4%) patients, respectively. Univariate analyses were done using Fishers exact and Chi-square tests. Multivariate analyses were done using logistic regression test to determine predictive factors affecting cure and complication rates. Mean surgical and hospitalization times were 34.7 min (20–70) and 1.2 days (1–5), respectively. Mean follow-up was 21.6 months (6–38). Cure and improvement rates were 89 and 8%, respectively. Thirty-one complications were observed in 27 (36%) patients. Intraoperative bladder perforation and bleeding occurred in three (4%) and two (3%) patients, respectively. Sixty-six (88%) patients voided spontaneously after TVT while nine (12%) performed clean intermittent catheterization (CIC) for a period of time. Seven of nine patients regained the spontaneous voiding ability within 1 month. The tape was cut in two of these retentive patients and one with severe storage lower urinary tract symptoms (LUTS) either unilaterally or bilaterally. On univariate (Fishers exact test, p =0.018), and multivariate (Logistic regression, p =0.013) analyses, patient age was the only statistically significant parameter affecting the cure rate, which was significantly lower particularly over 55 years of age. No significant factor predicting the complications was detected. TVT is an effective and safe surgical procedure in the treatment of SUI. In this study age was the only significant predictive factor affecting the cure rate while no significant factor predicting the complications was detected. Cure rate was significantly lower in patients over 55 years of age. Editorial Comment: This review of the TVT experience in the authors institution again reports a fairly high success rate with this procedure. Contrary to some other articles, the type of anesthesia did not appear to affect cure rate, but the patients age did. In addition, prior incontinence surgery, and whether the procedure was performed by attending or resident, did not affect the most common complication, which was intraoperative bladder perforation. Interestingly, the authors report that most of the bladder perforations were not obvious on cystoscopy, but were found when urine extruded from the suprapubic incisions. A note of caution to all surgeons.     

The effects of duloxetine on urethral function and sphincter morphology

The aim of our study was to investigate the effect of duloxetine on urethral function and sphincter ultrasound morphology in 54 women, who were referred to a urogynecology unit, with urodynamic stress incontinence. All completed a King’s Health Questionnaire and a patient global assessment of improvement (PGI-I) question and underwent urethral pressure profilometry, measurement of urethral retro-resistance pressure (URP), and ultrasound of the striated urethral sphincter. The investigations were repeated after 8 weeks of duloxetine 40 mg twice daily in 36 women who continued the medication. After 8 weeks of duloxetine, the mean URP increased significantly compared to baseline (53.8 to 60.8 cm H₂O; p = 0.001), and sphincter thickness was significantly higher (1.8 to 2.0 mm; p < 0.001). There was a significant increase in the maximum urethral closure pressure (MUCP) (52.7 to 59.2 cm H₂O; p = 0.006) but not of functional urethral length. Subanalysis of responders (improved on duloxetine) showed a significant increase in URP (50.3 to 59.1 cm H₂O; p = 0.001), sphincter thickness (1.7 to 2.1 mm; p < 0.001), and MUCP (50.2 to 58.1 cm H₂O; p = 0.03). These changes were not seen in nonresponders. This study has demonstrated objective changes in urethral ultrasound morphology and function after duloxetine therapy, which relate to improved continence. A larger longer term study is required to assess if these changes persist over time. In summary, duloxetine therapy for urodynamic stress incontinence results in an increase in urethral closure pressure, URP measurement, and urethral striated sphincter thickness.     

经耻骨后及经闭孔无张力阴道吊带术治疗女性压力性尿失禁的效果

目的对比观察经耻骨后径路无张力阴道吊带术(TVT)和经闭孔径路无张力阴道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的效果。方法2002年6月至2005年5月,行女性SUI无张力阴道吊带术81例。患者年龄35~79岁,平均51岁。病程6个月~30年。其中行TVT58例、行TVT-O术者23例。以术后增加腹压有无尿液溢出为疗效判断标准。结果TVT组TVT-O组手术时间分别为30~60min[平均(36.4±7.6)min]、20~35min[平均(24.4±5.1)min](P<0.01)。81例中,74例(91.4%)尿失禁症状完全消失,5例(6.2%)改善,2例(2.5%)失败。TVT组治愈52例(89.7%)、改善4例(6.9%)、失败2例(3.4%);TVT-O组治愈22例(95.7%)、改善1例(4.3%);2组比较差异无统计学意义(P>0.05)。TVT组和TVT-O组分别有6例(10.3%)和2例(8.7%)发生术后排尿困难;TVT组3例(5.2%)术中发生膀胱损伤,1例(1.7%)术后发生耻骨后血肿;TVT-O组3例(13.0%)术后2d内出现双下肢短暂性活动障碍自行缓解。结论无张力阴道吊带术是一种治疗女性SUI安全有效的方法,TVT-O较TVT更为简单,创伤更小,并发症轻。     

Use of three-dimensional ultrasound scan to assess the clinical importance of midurethral placement of the tension-free vaginal tape (TVT) for treatment of incontinence

The aim of the study is to illustrate that the midurethral positioning of the tension-free vaginal tape (TVT) may not be necessary to achieve continence. Our secondary aim is to highlight that a fair number of successfully performed TVT procedures do not result in midurethral position of the tape. A review of 31 women who underwent TVT operations and consecutively returned for their follow-up visits from July 2003 to November 2003 was conducted. Their TVT procedures were performed between March 2000 and August 2003. Transperineal three-dimensional ultrasound was used to identify and obtain objective measurements of the position of the TVT tape relative to the urethra. Any patients with significant coexisting vault or uterovaginal prolapse were surgically corrected at the same time. Their stress urinary incontinence was objectively diagnosed by performing urodynamic studies (dual-channel subtraction cystometry, erect stress test) in the outpatient urogynaecology clinic. Postoperatively, patients were reviewed at 1 month and then at 6 months followed by annual reviews subsequently. All women were reassessed at the 6-month follow-up visit with a filling and voiding cystometry to detect recurrent genuine stress incontinence and detrusor instability. Any woman complaining of stress urinary incontinence after that was reassessed with urodynamic studies as mentioned above. The majority of women (67.7%, 21 women) had the TVT tape located in the middle one-third of the urethra; 9.7% (3 women) and 22.6% (7 women) of women had the TVT tape situated in the proximal and distal one-third of the urethra, respectively. Despite this, all 31 women remained continent at their postoperative follow-up visits. The midurethral position of the TVT tape may not be essential in restoring continence. The TVT tape once inserted may not always rest in the midurethral position as described.     

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.     

Incontinence-related quality of life and sexual function following the tension-free vaginal tape versus the “inside–out” tension-free vaginal tape obturator

The objective of this cohort study was to compare morbidity, quality of life, and sexual function in stress-incontinent women treated with tension-free vaginal tape (TVT) versus tension-free vaginal tape obturator (TVT-O) in a group of 329. Preoperative scores of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were compared to those from a mailed, postoperative questionnaire. The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-12) and three additional questions were also included in the mailing. Of the initial 329 patients, 239 (73%) completed the questionnaire with a mean follow-up of 14.7 months. Complications, return to normal voiding, and operative time were less in the TVT-O group. Postoperative PISQ-12 scores and improvements in the UDI-6 and IIQ-7 were comparable between groups. The TVT-O procedure appears to be as effective in improving incontinence-related quality of life as the TVT. No differences in sexual function were demonstrated between groups.     

Preoperative maximal flow rate may be a predictive factor for the outcome of tension-free vaginal tape procedure for stress urinary incontinence

This study examined factors potentially predicting on the outcome of the tension-free vaginal tape procedure for stress urinary incontinence. A total of 60 women (aged 35–71 years, mean 57) with at least follow-up of 2 years were included in the study. The tension-free vaginal tape procedure was performed under local anesthesia except in two patients. At the latest follow-up 50 (83.3%) were cured of stress urinary incontinence. Two patients had new-onset urge symptoms without urge incontinence episodes. Multivariate regression analysis showed maximal flow rate to be associated with 0.9-fold risk of the failure; no other parameters had statistical significance. Our results confirm the feasibility and safety of the tension-free vaginal tape procedure and demonstrate that preoperative low maximal flow rate may be associated with the failure of the tension-free vaginal tape procedure.Editorial comment: The authors in this study evaluated the outcome of the tension-free vaginal tape based on subjective and objective parameters and evaluated possible predictors of failure associated with this procedure using univariate and multivariate logistic regression analysis. Their rates of cure, improvement, and failure of, respectively, 83.3%, 11.7%, and 5.0% are comparable to those of other studies. Of all the clinical parameters evaluated they found only one statistically significant variable associated with outcome. Higher preoperative maximal flow rate was associated with a decreased likelihood of failure. The authors propose several hypotheses to explain for this finding, including poor detrusor contractility, low urethral mobility during the voiding phase, and low urethral pressure. To provide clinical usefulness one needs to determine at what cutoff does maximum flow rate become a risk factor for failure of the TVT.     

经阴道无张力悬吊术治疗女性压力性尿失禁及并发症防治

目的 探讨女性压力性尿失禁（SUI）的微创手术治疗效果及并发症的防治。方法2002年10月至2004年12月采用经阴道无张力悬吊带术（TVT）治疗女性SUI患者33例，2例合并子宫肌瘤者同时行腹腔镜子宫切除术。出院前行1h尿垫试验观察疗效，术后3个月行尿流率和膀胱剩余尿测定观察对排尿的影响。结果 33例患者手术时间25～50min，平均33min，出血量10～23ml，平均18ml。术中膀胱穿孔3例，双侧1例、单侧2例。耻骨后血肿2例，经保守治疗痊愈。术后24～48h30例拔尿管，平均38h，3例膀胱穿孔者拔管时间为4～5d。32例患者排尿良好，1例出现尿潴留。随访1～29个月，患者可自主控尿30例，1h尿垫试验由术前的平均46g（10～85g）降至术后1．2g（0～2g），其余3例用力咳嗽时有少许尿液滴出，1h尿垫试验平均为5．2g（3～9．5g），总治愈率91％（30／33），显效3例。术后3个月31例行尿流率和剩余尿测定，平均尿流率（ml／s）、最大尿流率（ml／s）和剩余尿量（m1）术前为10．4、21．5、10．5，术后为11．5、20．4、11．8，手术前后比较差异无统计学意义（P〉0．05）。结论　经阴道尿道中段无张力悬吊带术可安全有效治疗女性压力性尿失禁。     

Needle tip control and its effect in reducing intraoperative complications during tension-free vaginal tape placement

Tactile needle tip control was used to aid perforation during standard tension-free vaginal tape (TVT) placement to treat urinary incontinence. The success and complications of this novel method were compared retrospectively with the reported results of the standard technique. One hundred nine patients had TVT placement between 1998 and 2001, with follow-up continuing into 2002. Preoperatively, the severity of urinary incontinence was assessed objectively. Postoperatively, TVT effectiveness was assessed subjectively by standardized questionnaire, completed by 78 of the 109 patients (72%). Objective 2-year rates for continence or improvement and most complication rates were similar to previously reported results. Needle tip control was helpful in lowering the occurrence of bladder perforation. Longer postoperative recovery times associated with postoperative dysuria or obstruction did not decrease patient satisfaction if the patient experienced a marked improvement in leakage.Abbreviations ISD Intrinsic sphincter deficiency - TVT Tension-free vaginal tape Editorial Comment: The authors report a single-center single-surgeon experience with the TVT sling procedure. It is a series of 109 women in a real-world setting. As such, inclusion and exclusion criteria as well as endpoints are not well defined and not objective. The study demonstrated good results with the procedure, which are very consistent with many previously published papers. The authors stress important technical aspects of the procedure to avoid migration of the tip of the needle.     

Treatment outcome of tension-free vaginal tape in stress urinary incontinence: comparison of intrinsic sphincter deficiency and nonintrinsic sphincter deficiency patients

The object of this study was to compare the treatment outcomes of tension-free vaginal tape (TVT) for intrinsic sphincter deficiency (ISD) and nonintrinsic sphincter deficiency (NISD) patients in stress urinary incontinence (SUI) and to evaluate whether TVT can be effectively used in both groups of patients. 111 women with SUI treated by TVT procedure from June 2003 to June 2005 with follow-ups for at least 1 year postoperatively were included in this study. The patients were divided into two groups: 31 patients with ISD and 80 patients with NISD. ISD was defined as the cases with low Valsalva leak-point pressure (VLPP) or Maximal urethral closure pressure (MUCP). Patients were followed up at 1, 3, 6, and 12 months postoperatively. There were no significant differences found in demographics between ISD and NISD groups: mean age, parity, body mass index, menopausal status, and hormone replacement therapy (p > 0.05). All urodynamic parameters except for VLPP and MUCP showed no significant differences. The cure rates of the two groups at 1 month follow-up (87.0 vs 100%; p = 0.0053) showed a significant difference, but no significant differences were found at 3, 6, and 12 months. There were no differences in postoperative complication rates (voiding difficulty, de novo urgency, urinary tract infection, retropubic hematoma, and vaginal mesh erosion) between the two groups irrelevant of follow-up months. TVT is effective for SUI in both ISD and NISD patients.     

Five-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence

OBJECTIVES: We evaluated the long-term efficacy and safety of a tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence (SUI) in a Korean population. METHODS: We included 134 patients (mean age, 52.3+/-9.3 yr) who underwent the TVT procedure for SUI in three institutions and followed for 5 yr (mean, 67.0 mo; range, 60-76 mo) postoperatively. We analysed voiding diaries and complete multichannel urodynamic studies preoperatively as well as cough stress tests, uroflowmetry, and questionnaires postoperatively. RESULTS: The overall 5-yr success rates (cure/improved) were 94.9% (76.9% and 18.0%, respectively), with an 86.6% patient satisfaction rate. Although the success rates between 1 and 5 yr were similar (97.7% vs. 94.9%), the cure rate decreased from 90.1% to 76.9% (p<0.001) at 5 yr. The 5-yr cure rate for mixed urinary incontinence (MUI) was 72.0%, which was not significantly different from pure SUI (78.0%, p>0.05). Maximal flow rate dropped from 25.9+/-10.3ml/s to 20.4+/-8.6ml/s at 1 mo postoperatively and recovered to 24.8+/-8.5ml/s at 5 yr. Complications included bladder perforation in 5 patients (3.7%), tape cutting or release in 11 (8.2%), and persistent suprapubic pain in 3 (2.2%). Urgency and urge incontinence improved in 46.7% and 48.0% of patients, respectively. CONCLUSIONS: TVT was an effective and safe procedure for SUI and MUI with high success rates in the long-term follow-up. It also improved concomitant overactive bladder symptoms and initially reduced postoperative urine flow, which recovered over time.     

A transvaginal ultrasound study comparing transobturator tape and tension-free vaginal tape after surgical treatment of female stress urinary incontinence

This study was carried out to compare ultrasonographic findings on patients after transobturator tape (TOT) and tension-free vaginal tape (TVT) procedures to evaluate displacement of tapes up to a 2-year follow-up and to test the correlation between bladder outlet obstruction and the tape position. Forty-nine patients had a transvaginal ultrasonographic evaluation after TOT (n=31) or TVT (n=18) procedures. Twenty-one patients from the TOT group and 12 from the TVT group had ultrasonographic evaluation both at 1 and 2 years follow-up. Tape position was evaluated with a complete sagittal view, and the width of the tape and the distance between the middle of the tape and the bladder neck were measured. Statistical analysis was performed using a t test. After clinical evaluation, stress test, and uroflowmetry with residual measurement, the tapes were compared on ultrasound with regard to clinical and urodynamic results: success in stress incontinence vs failure, bladder outlet obstruction vs no obstruction, and de novo urgencies vs no urgencies. No difference was found between TOT and TVT in the midurethral tape placement. The distance between the middle of the tape and the bladder neck at rest was similar at both 1 and 2 years after both TOT and TVT and was unchanged after coughing or Valsalva. The width of the tape was similar after TOT and TVT at both 1 and 2 years after the procedure. There was no difference in the distance between the middle of the tape and the bladder neck between cured patients, failure, bladder outlet obstruction, and de novo urgencies after both TOT and TVT. Transvaginal ultrasound examination showed no significant difference in the tape position between TOT and TVT. No correlation was found between ultrasonographic findings and postoperative voiding troubles for both techniques.     

Single-Incision Mini-Slings Versus Standard Midurethral Slings in Surgical Management of Female Stress Urinary Incontinence: An Updated Systematic Review and Meta-analysis of Effectiveness and Complications

ContextAn updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI).ObjectiveTo evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI.Evidence acquisitionA literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri- and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice.Evidence synthesisA total of 26 RCTs (n = 3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95% confidence interval [CI], 0.88–1.00) and objective cure rates (RR: 0.98; 95% CI, 0.94–1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: −2.94; 95% CI, −4.16 to −1.73) and earlier return to normal activities and to work (WMD: −5.08; 95% CI, −9.59 to −0.56 and WMD: −7.20; 95% CI, −12.43 to −1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95% CI, 0.93–4.31).ConclusionsThis meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included.     

自制可调吊带治疗女性压力性尿失禁16例临床观察

目的:探讨应用自制吊带在经阴道无张力性尿道中段悬吊术(TVT)中的临床价值。方法:采用美国强生公司生产的prolene材料的网状疝气补片,自制成TVT吊带,对16例平均年龄为59.2岁、病程4-11年的压力性尿失禁患者施行TVT手术。结果:16例患者术后随访6个月-2年,9例压力试验和尿垫试验<2 g/h,生活质量评分改善90%以上;7例尿失禁量减少80%以上,尿垫试验<10 g/h,生活质量评分改善达到75%以上。均无伤口感染,2例出现尿潴留,2例穿透膀胱颈。结论:自制TVT吊带过程简单,价格便宜,手术疗效确切,创伤小,患者恢复快,易于推广。     

TVT术对尿道固有括约肌功能缺陷的女性压力性尿失禁患者的临床观察

目的:探讨TVT悬吊术治疗有尿道固有括约肌功能缺陷(ISD)的女性压力性尿失禁(SUI)患者的疗效.方法:采用TVT悬吊术治疗女性SUI患者114例,将ISD和无ISD患者的疗效进行比较.结果:114例中获得随访者110例(96.5%):无ISD者92例,治愈81例(88.0%),有效10例(10.9%),完全失败1例(1.1%);有ISD者18例,治愈12例(66.7%),有效3例(16.7%),完全失败3例(16.7%).术后有7例患者出现明显的排尿困难,其中2例为剩余尿阴性的ISD患者,差异有统计学意义.结论:TVT悬吊术是一种治疗女性SUI患者安全、有效和微创的治疗手段,对有ISD的女性SUI患者同样有效,但疗效不如无ISD的患者;特别是当患者年龄大于65岁、最大尿道关闭压小于0.981 kPa或尿道活动度小时,其治疗效果较差.TVT悬吊术治疗ISD时仍应遵循该术式的常规操作.     

Updated Systematic Review and Meta-Analysis of the Comparative Data on Colposuspensions,Pubovaginal Slings,and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence

Context

Burch colposuspension, pubovaginal sling, and midurethral retropubic tape (RT) and transobturator tape (TOT) have been the most popular surgical treatments for female stress urinary incontinence (SUI). Several randomized controlled trials (RCTs) have been published comparing the different techniques, with conflicting results.

Objective

Our aim was to evaluate the efficacy, complication, and reoperation rates of midurethral tapes compared with other surgical treatments for female SUI.

Evidence acquisition

A systematic review of the literature was performed using the Medline, Embase, Scopus, Web of Science databases, and Cochrane Database of Systematic Reviews.

Evidence synthesis

Thirty-nine RCTs were identified. Patients receiving midurethral tapes had significantly higher overall (odds ratio [OR]: 0.61; confidence interval [CI]: 0.46–0.82; p = 0.00009) and objective (OR: 0.38; CI: 0.25–0.57; p < 0.0001) cure rates than those receiving Burch colposuspension, although they had a higher risk of bladder perforations (OR: 4.94; CI: 2.09–11.68; p = 0.00003). Patients undergoing midurethral tapes and pubovaginal slings had similar cure rates, although the latter were slightly more likely to experience storage lower urinary tract symptoms (LUTS) (OR: 0.31; CI: 0.10–0.94; p = 0.04) and had a higher reoperation rate (OR: 0.31; CI: 0.12–0.82; p = 0.02). Patients treated with RT had slightly higher objective cure rates (OR: 0.8;CI: 0.65–0.99; p = 0.04) than those treated with TOT; however, subjective cure rates were similar, and patients treated with TOT had a much lower risk of bladder and vaginal perforations (OR: 2.5; CI: 1.75–3.57; p < 0.00001), hematoma (OR: 2.62; CI: 1.35–5.08; p = 0.005), and storage LUTS (OR: 1.35; CI: 1.05–1.72; p = 0.02). Meta-analysis demonstrated similar outcomes for TVT-O (University of Liège, Liège, Wallonia, Belgium) and Monarc (AMS, Minnetonka, MN, USA).

Conclusions

Patients treated with RT experienced slightly higher continence rates than those treated with Burch colposuspension, but they faced a much higher risk of intraoperative complications. RT and pubovaginal slings were similarly effective, although patients with pubovaginal slings were more likely to experience storage LUTS. The use of RT was followed by objective cure rates slightly higher than TOT, but subjective cure rates were similar. TOT had a lower risk of bladder and vaginal perforations and storage LUTS than RT. The strength of these findings is limited by the heterogeneity of the outcome measures and the short length of follow-up.     

Tension-free vaginal tape: analysis of risk factors for failures

To investigate whether there are any demographic, clinical, or urodynamic variables associated with an increased risk of failure in women undergoing surgery with tension-free vaginal tape (TVT). We retrospectively analysed 325 consecutive patients who had been operated with the TVT procedure. Patients were assessed with a complete history, physical examination, and urodynamic testing. The operation was done under local or epidural anesthesia and any further surgical procedure was added as indicated. The postoperative evaluation included collection of data on intra- and postoperative complications and analysis of outcomes. The outcome of surgical treatment was evaluated subjectively and objectively. The Statistical Package for Social Sciences (SPSS, Chicago, Illinois, USA) was used for data analysis; P<0.05 was considered significant. The overall complication rate was 14%, voiding dysfunction being the most common. Three hundred and one women were available for the analysis of surgical outcome and the mean follow-up was 34+12 months (median 32 months). Subjectively, 269 women (89%) were cured by the procedure and 13 (4.3%) reported marked improvement. An objective cure was achieved in 263 (87%); 38 patients still having leakage while coughing during postoperative cystometry. Among the numerous presumed risk factors for failed antiincontinence surgery only urethral hypomobility and recurrent stress urinary incontinence were significantly associated with failure of the TVT procedure in our study. However, even in these complicated situations, the cure rate was more than 70%.     

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。