Tension-free vaginal tape (TVT) for the treatment of occult stress urinary incontinence in women undergoing prolapse repair: a prospective study of 100 consecutive cases

AIMS: Clinically continent women with genitourinary prolapse and occult stress urinary incontinence (SUI) are considered to be at high risk of developing symptomatic SUI once the prolapse is repaired. We studied the efficacy and safety of tension-free vaginal tape (TVT) procedure in preventing postoperative SUI in these women. METHODS: One hundred consecutive women (mean age 66.7 +/- 9.9 years) with significant genitourinary prolapse and occult SUI were prospectively enrolled. Preoperatively, none of the women complained of SUI. However, all had urodynamically-confirmed occult SUI, revealed by repositioning of the prolapse. Surgical intervention was comprised of transvaginal prolapse repair and prophylactic TVT procedure. Main outcome end points included operative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS: The mean follow-up period was 27 months (range: 12-52 months). There was only one case of technique-related bladder perforation with no adverse outcome. Two other patients had postoperative urinary retention necessitating catheterization for more than 7 days, none of whom required any surgical intervention. Vaginal erosion of the tape was diagnosed in three patients, all of whom were successfully treated by excision of the eroded tape. Two (2%) patients developed urodynamically-confirmed SUI within 1 year postoperatively. However, postoperative urodynamics revealed asymptomatic sphincteric incontinence in 15 (15%) other patients. Thirteen (72%) of 18 patients with preoperative urge incontinence had postoperative persistent urge incontinence. De novo urge incontinence developed postoperatively in 8 (8%) patients. CONCLUSIONS: TVT procedure is effective and safe in patients with occult SUI undergoing prolapse repair. Long-term durability of this procedure is yet to be established.     

Impact of tension-free vaginal tape on sexual function: results of a prospective study

The purpose of this study was to prospectively assess the impact of a TVT insertion for the treatment of stress urinary incontinence (SUI) on coital incontinence and overall sexual life. Sexually active women with pure SUI and without concomitant pelvic organ prolapse scheduled for TVT procedure completed a sexual function questionnaire at baseline and 6 months after surgery. Fifty-three patients were enrolled. Preoperatively 23 (43.4%) women experienced urine leakage during intercourse, 21 (91%) during penetration and 2 (9%) on orgasm. The objective cure rate for SUI was 98%. Coital incontinence was cured in 20 of 23 patients (87%). Thirty-three (62.2%) women reported no change in sexual function after surgery and 18 (34%) reported an improvement. Of the latter, 17 (94%) were of those cured from coital incontinence. No significant difference in the incidence of dyspareunia was found postoperatively. Two patients (3.8%) reported intercourse to be worse following surgery, one because of a vaginal erosion and one cited de novo anorgasmia as the main reason.     

Tension Free Vaginal Tape Versus Burch Colposuspension for Treatment of Female Stress Urinary Incontinence

Introduction: Many surgical procedures have been proposed for treatment of stress urinary incontinence (SUI) but none of them has proved completely successful. The aim of this study is to compare the efficacy and safety of tension free vaginal tape (TVT) with Burch colposuspension in the treatment of SIU. Patients and Methods: Fifty female patients, presenting with SUI were randomly divided into two equal groups. SUI was confirmed using urodynamic study in all patients. Group 1 (n=25) patients underwent Burch colposuspension while Group 2 (n=25) underwent TVT. Patients with high grade cystocele, previous surgical failure for SUI, uninhibited detrusor contraction during bladder filling on urodynamic study and incompetent internal sphincters were excluded from this study. A patient was declared cured of SUI, if 3–6 months after surgery she had no SUI. The procedure was judged to be a failure if 3–6 months after surgery, patient had SUI. Results: In group 1 patients, 72% were completely cured, 16% improved and 12% showed no improvement. In group 2 patients, 72 were completely cured, 20% improved and only 8% showed no improvement. There was no difference between the two groups in terms of cure rates. Operative time for TVT was significantly less compared to Burch. Postoperative pain was less in TVT than Burch. Return to normal activity was earlier in TVT compared to Burch group. Intra operative perforation of the urinary bladder occurred in 8% of patients in group 2. Urine retention occurred in 12% of patients in group 1 compared to 20% in group 2. This was successfully managed conservatively. De novo urgency developed in 12% in group I and 8% in group II and was successfully managed by medical treatment. Conclusion: The success rates of TVT and Burch colposuspension in the treatment of SUI in our experience are very similar. However, TVT is associated with less morbidity. We recommend TVT procedure for females with genuine SUI.     

The 7‐year outcome of the tension‐free vaginal tape procedure for treating female stress urinary incontinence

OBJECTIVE

To evaluate the long‐term results and predictive risk factors for efficacy after the tension‐free vaginal tape (TVT) procedure for treating female stress urinary incontinence (SUI).

PATIENTS AND METHODS

Inall, 306 women (mean age 50.7 years, sd 8.7) who had a TVT procedure for SUI were selected and followed ≥7 years (mean 92.3 months, range 84–110) after surgery. We analysed the long‐term results, the variables predictive of cure rates, and patient satisfaction.

RESULTS

The overall 7‐year cure rate was 84.6%, with a satisfaction rate of 69.3%. The cure rates were lower in patients with high‐grade SUI (50% in grade III, 82.8% in grade II and 90.7% in grade I; P < 0.001). On multivariate analysis, there were no independent risk factors related to cure rate, and urgency was the only factor independently associated with patient satisfaction (P = 0.008; odds ratio 2.47). Seventy‐one patients (23.2%) had complications at the 1‐month follow‐up after surgery, but only eight (2.6%) had complications at the 7‐year follow‐up, including mesh exposure in six and de novo urgency in two.

CONCLUSION

The absence of long‐term adverse events associated with the TVT procedure, and high subjective and objective 7‐year success rates with no independent predictive factors affecting the long‐term cure rate, make the TVT procedure a recommendable surgical treatment for female SUI.     

A randomized controlled equivalence trial of short-term complications and efficacy of tension-free vaginal tape and suprapubic urethral support sling for treating stress incontinence

OBJECTIVE: To establish the equivalence between the tension-free vaginal tape (TVT) and the suprapubic urethral support sling (SPARC). Approximately 35% of women have stress urinary incontinence (SUI), and although TVT is now perceived as the standard treatment, the SPARC is a very similar procedure and is thought to have fewer peri-operative complications. PATIENTS AND METHODS: Patients with clinical SUI were recruited from public and private urology/urogynaecology clinics, and participated in the trial of TVT vs SPARC. The primary outcome was bladder perforation; secondary outcomes were blood loss, voiding difficulty, urgency, and cure of SUI symptoms. Sample size calculations, based on an estimated 2% perforation rate, showed that 290 patients would be needed to detect a clinically significant difference of 5%. Stratification was by previous incontinence surgery and the experience of the surgeon. RESULTS: There were 301 operations; the difference in bladder perforations was not statistically significant, at one/147 TVT (0.7%), and three/154 SPARC (1.9%), with the difference in rate of 0.013 (95% confidence interval (CI) - 0.01 to 0.04; odds ratio 2.89, 95% CI 0.30-28.21; P = 0.62), and nor were differences in estimated blood loss of >100 mL (TVT, 32/147, 21.8%; SPARC 28/154, 18.2%); de novo urgency (TVT 15/37, 40.5%; SPARC 14/33, 42.4%), objective cure (TVT 143/147, 97.3%; SPARC 148/152, 97.4%) or vaginal mesh erosion (TVT 7/147, 4.8%; SPARC 16/152, 10.5%). Acute urinary retention (TVT none of 147; SPARC 10/154, 6.5%; odds ratio infinity, 95% CI 2.2-infinity; P = 0.002) and subjective cure (TVT 128/147, 87.1%; SPARC 117/153, 76.5%; odds ratio 2.07, 95% CI 1.13-3.81; P = 0.03) were statistically significantly different. CONCLUSION: These results are consistent with clinical equivalence between TVT and SPARC for bladder perforation. There was no statistically significant difference between TVT and SPARC in blood loss, urgency or objective cure of SUI symptoms at 6 weeks. However, SPARC was more difficult to adjust correctly, and a statistically significant number of patients required loosening of the tape in theatre (P = 0.002). TVT had a lower rate of vaginal erosion and a statistically significantly higher cure rate of subjective SUI symptoms than SPARC. Overall, voiding difficulty (loosening of the tape), urgency and vaginal mesh erosion were the most important clinical problems. This trial showed the importance of testing new devices which appear to be similar, but which might have relevant differences. There was no financial assistance for this study, and a long-term follow up is planned.     

Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence

AIM: We report the clinical and urodynamic outcomes of the pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence (SUI) and determined the urodynamic parameters that could predict the occurrence of postoperative voiding difficulty. METHODS: Between 1998 and 2005, a total of 29 consecutive women with SUI underwent pubovaginal sling surgery with autologous rectus fascia. Patients were preoperatively and postoperatively evaluated with regard to symptoms and urodynamic findings including uroflowmetry (UFM), postvoid residual urine volume (PVR), filling cystometry (CMG) and pressure flow study (PFS). RESULTS: Overall SUI was cured in 23 patients (80%) and improved in 3 patients (10%). Three patients (10%) who developed persistent urinary retention or severe voiding difficulty after surgery underwent urethrolysis. Of 17 patients who had urgency before the pubovaginal sling, urgency was cured postoperatively in seven, while de novo urgency appeared in one patient. Maximum flow rate (Qmax) in UFM was significantly decreased (P < 0.05) and PVR was increased (P = 0.08) after surgery. PFS showed a significant increase in detrusor opening pressure and detrusor pressure at Qmax (P < 0.01) after surgery. Eight patients (28%) needed prolonged intermittent self-catheterization. Patients who had PVR >100 mL (P < 0.05) or Qmax < or = 20 mL/s (P = 0.09) in preoperative UFM were more likely to require prolonged intermittent catheterization after surgery. CONCLUSIONS: The pubovaginal sling procedure with autologous rectus fascia is an effective treatment for SUI. A comparison of preoperative and postoperative urodynamic parameters indicates an increase in urethral resistance after pubovaginal sling surgery. PVR >100 mL and Qmax < or = 20 mL/s before surgery are risk factors for postoperative voiding difficulty.     

Short‐term assessment of a tension‐free vaginal tape for treating female stress urinary incontinence

OBJECTIVE

To evaluate the short‐term surgical complications and results of a tension‐free vaginal tape (TVT) system (TVT‐Secur^TM, Gynecare, Ethicon, Somerville, NJ, USA) in the treatment of female stress urinary incontinence (SUI).

PATIENTS AND METHODS

TVT‐Secur was applied to 107 women with SUI through a vaginal incision and left abutting the urethra. Postoperative pain, complications, de novo lower urinary tract symptoms, incontinence cure rate and the King’s Health Questionnaire (KHQ) score were evaluated.

RESULTS

The operative duration was 12 min; the mean pain score was 2.3 and only one patient had transient voiding difficulties. After a mean follow‐up of 15 months, 71% of the patients were dry and 14% improved. The KHQ scores decreased significantly for most subscores. Urgency appeared de novo in six patients (5.6%), and vaginal erosion required one TVT‐Secur explantation.

CONCLUSION

This study shows that TVT‐Secur is a simple and safe treatment for female SUI, but before recommending this sling as a first choice for treating SUI, TVT‐Secur must pass the test of time and comparative studies with conventional slings.     

Long‐term efficacy of the bone‐anchored male sling for moderate and severe stress urinary incontinence

Study Type – Therapy (outcomes research)
Level of Evidence 2c

OBJECTIVE

To present a prospective long‐term evaluation of the bone‐anchored male sling (InVance^TM, American Medical Systems, Minnetonka, MN, USA) for patients with moderate to severe stress urinary incontinence (SUI) after prostate surgery

PATIENTS AND METHODS

Forty‐five patients had a male sling implanted for SUI after prostate surgery. The evaluation before and after surgery included a complete history and physical examination, various questionnaires (American Urological Association Symptom Score, University of California Los Angeles/RAND prostate index), cysto‐urethroscopy, International Continence Society (ICS) 1‐h pad test and a urodynamic study. The follow‐up assessments were at 2, 6 and 12 months after surgery, and yearly thereafter. The success rate was defined as the percentage of patients ‘dry’ and ‘improved’.

RESULTS

The median (range) follow‐up was 36 (2–64) months. Twelve patients (27%) had previous adjuvant radiotherapy. Eighteen patients (40%) had moderate SUI (two or three pads/day) and 27 (60%) had severe SUI (more than three pads/day). All preoperative ICS 1‐h pad tests were positive. The success rate was 76%; 16 patients were dry (36%), 18 were improved (one or two pads/day, 40%) and in 11 the sling was a failure (24%); 76% of ICS 1‐h pad tests were negative after surgery. The postoperative urodynamic study showed no signs of bladder outlet obstruction. In all, 72% of patients were satisfied/very satisfied with the surgery and 86% considered themselves cured/almost cured. The success rate was not affected by the presence of previous radiotherapy or the severity of SUI. Ten patients had perineal numbness, but in all it resolved within 1–3 months. There was one mesh infection which required its removal. There was no urethral erosion.

CONCLUSION

Compared to previous studies, the InVance male sling had a good success rate for moderate and severe SUI, with a median follow‐up of 36 months. The results did not differ for moderate or severe SUI or with the presence of previous radiotherapy.     

Reasons for dissatisfaction ten years after TVT procedure

Introduction and hypothesis

The aim of the study was to assess the reasons for dissatisfaction 10 years after TVT placement.

Methods

Patients who underwent TVT surgery between 1999 and 2001 at two participating units were included. All patients who did not consider themselves to be cured were asked for their reasons.

Results

141 out of 210 patients (81 %) were available for follow-up (median 116 months). In the group of 56 patients who did not consider themselves cured, the reasons were OAB symptoms in 29 patients (52 %), stress urinary incontinence in 13 patients (23 %), and complaints of mixed urinary incontinence in 8 patients (14 %). 85 % of all patients reporting urgency complaints at the time of follow-up and 66 % of patients with SUI at the time of follow-up did not consider themselves cured.

Conclusions

In most cases overactive bladder symptoms were the reason for dissatisfaction. The results of this study support using composite outcomes to assess the results of surgery for urinary incontinence.     

Extraperitoneal laparoscopic urethropexy with Marlex mesh

OBJECTIVES: Extraperitoneal laparoscopic urethropexy (ELU) has recently been developed as a minimally invasive procedure for the treatment of female stress urinary incontinence (SUI). Use of the laparoscopic stapling device and Marlex mesh in the extraperitoneal space may allow for a technically easier procedure and shorter operative times compared with other laparoscopic techniques without compromising long-term efficacy. We present our initial results and 2.5-year interim analysis with this alternative method of laparoscopic urethropexy. METHODS: Twenty-four consecutive patients with urodynamically demonstrated genuine SUI underwent attempted ELU at a single institution from December 1994 to December 1995. Operative data were collected from the patient chart, and follow-up data were obtained by telephone interview. Treatment was considered successful if, at last follow-up, a patient was using one or fewer pads daily and would recommend the procedure to a friend. RESULTS: ELU was completed in 22 of 24 patients. In 1 patient with a prior history of pelvic surgery, the preperitoneal space was not accessible. Of the 22 patients, 20 were available for follow-up. The mean operative time was 69 minutes. There were no intraoperative complications. At initial follow-up (mean 10.5 months), 18 (90%) of 20 patients reported subjective cure of SUI (one or fewer pads daily). At a mean follow-up of 29 months (range 23 to 34), 16 (80%) of 20 patients had subjective cure of SUI. Six patients would not recommend the procedure to a friend, all of whom had de novo urgency and/or urge incontinence. Thus, using our strict criteria, ELU was successful in 14 (70%) of 20 patients at a mean follow-up of 2.5 years. No patient has had permanent urinary retention. CONCLUSIONS: ELU can be performed rapidly and safely in patients without previous pelvic surgery. De novo urgency incontinence may be problematic. Future analysis of this subset of patients will determine whether this procedure is durable in the long term.     

Long-term follow-up of the retropubic tension-free vaginal tape procedure

Introduction and hypothesis

Retropubic tension-free vaginal tape (TVT) was introduced in 1996 as a new and innovative surgical approach in the treatment of stress urinary incontinence (SUI). In this study we evaluate the long-term objective and subjective outcomes in a non-selected patient population 10 years after the retropubic TVT procedure.

Methods

All women (603) operated on with retropubic TVT at four gynecological departments from September 1998 through December 2000 were identified, and those still alive (542) were invited to participate in this population-based prospective study. For subjective data a short-form urinary incontinence disease-specific questionnaire was used. For objective evaluation the women underwent a stress test. Data collected were merged with previously stored data in the Norwegian National Incontinence Registry Database.

Results

We included 483 women; 327 attended a clinical follow-up consultation and 156 had a telephone interview. Median duration of follow-up was 129 months. Objective cure rate was 89.9 %, subjective cure rate was 76.1 %, and 82.6 % of the patients stated they were “very satisfied” with their surgery (treatment satisfaction rate). Only 2.3 % of the women had undergone repeat SUI surgery. Subjective voiding difficulties were reported by 22.8 %, the majority describing slow stream or intermittency. De novo urgency incontinence increased significantly from 4.1 % 6–12 months after surgery to 14.9 % at the 10-year follow-up.

Conclusions

Long-term objective and subjective outcome after retropubic TVT is excellent with a low number of re-operations even in a non-selected cohort of patients.     

The long term (5-years) objective TVT success rate does not depend on predictive factors at multivariate analysis: a multicentre retrospective study

OBJECTIVES: We evaluated the predictive risk factors that could affect the long-term efficacy of the tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence (SUI). METHODS: One hundred thirty-eight (mean age, 52.4+/-9.3 yr) women who underwent the TVT procedure for SUI were selected and followed up for at least 5 yr (mean, 67.2 mo; range, 60-76) after the surgery. We analyzed the preoperative and intraoperative parameters using univariate and multivariate regression for cure rates and patients' satisfaction. RESULTS: The overall 5-yr cure rate was 76.8%, with a satisfaction rate of 86.9%. The cure rates were lower in patients with high body mass index (BMI>or=25 kg/m2/BMI<25 kg/m2=68.3%:83.3%, p=0.044), low abdominal leak point pressure (ALPP<60 cm H2O/ALPP>or=60 cm H2O=51.6%:82.8%, p=0.003), and high grade of SUI (40.0% in grade III; 69.7% in grade II; 86.6% in grade I, p=0.012). On multivariate analysis, there were no independent risk factors related to cure rate, and urgency was the only factor independently associated with patients' satisfaction (p=0.017; odds ratio=4.114). CONCLUSIONS: This study demonstrates that the TVT procedure is effective for female SUI without any independent predictive factors affecting long-term cure rate. Urgency was the only predictive factor affecting patient satisfaction. However, high BMI, low ALPP, and high grade of incontinence may impair the cure rate of the TVT.     

TVT our experience five years and six months later

ObjectiveWe present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfactionMaterial y methodsA sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried outResultsThe average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5,7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuatedConclusiónBursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanationAnyway we will have to check if the preliminary good results and no complications persist in the follow-up     

Dynamic suburethral suspension with pedicled external oblique aponeurosis in the management of female urinary incontinence.

PURPOSE: Despite excellent postoperative continence with pubovaginal sling procedures, the resultant morbidities of de novo urgency and urinary obstruction due to sling tension remain valid concerns. The feasibility and outcome of dynamic suburethral suspension using bilateral strips of external oblique aponeurosis left attached medially to the anterior rectus sheath and joined beneath the urethra under no tension were determined. MATERIALS AND METHODS: Between May 1995 and April 1998, 25 women with stress urinary incontinence were evaluated and underwent a dynamic suburethral suspension procedure. All patients were followed annually with a 10-point questionnaire by an independent registered nurse who analyzed the results, complications and satisfaction outcome. RESULTS: At a mean followup of 26 months all patients (100%) were cured of stress incontinence. Associated urge incontinence due to detrusor overactivity persisted in 3 patients postoperatively and, thus, the overall postoperative cure/dry rate was 88% for the study group. Of the 18 patients with preoperative urgency 12 (66%) were cured postoperatively. De novo urgency developed in 1 patient after surgery. No patient had prolonged urinary retention. Overall 92% of the patients were satisfied with the outcome of surgery. CONCLUSIONS: This dynamic suburethral suspension procedure cured stress incontinence in the majority of patients with no resultant urinary obstruction. The mechanism of action is believed to work by providing a viable suburethral "backboard" of support and by dynamic lifting of the proximal urethra cradled by the fascial loop precisely at the time of abdominal strain. Pronounced urge incontinence due to detrusor overactivity is unlikely to benefit from suspension procedures.     

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.     

Long-term durability,functional outcomes,and factors associated with surgical failure of tension-free vaginal tape procedure

Purpose

The cure rate of tension-free vaginal tape (TVT) appeared to decrease overtime, with an associated increased in the stress urinary incontinence (SUI) recurrence rate. We evaluated the long-term durability and functional outcomes of TVT and identified the risk factors that may affect recurrence.

Methods

Eighty-eight patients, who were cured of SUI 6 months after undergoing TVT, were followed-up for at least 12 years. At post-operative, the patients were evaluated with a Severity Index for Urinary Incontinence questions regarding cure, patient’s satisfaction, goal achievement, 3-day voiding diary with urinary urgency scale, uroflowmetry, and complications.

Results

Cure rates decreased from 96.6 % at 1-year post-surgery to 83.0 % at 5 years and that the cure rates between 5 and 12 year were similar (83.0 vs. 79.6 %). Valsalva leak point pressure (VLPP) < 60 H₂O was the only independent factor that predicted recurrence (p = 0.011; hazard radio 5.31). At last follow-up, 39.2 and 70.0 % of patients were free of urgency and urgency incontinence, respectively; and de novo urgency and urgency incontinence developed in 40.5 and 17.2 % of these patients, respectively. Age was the only factor that predicted freedom from overactive bladder (OAB) symptom. There was a significant reduction in the maximal flow rate from 23.3 ± 9.0 ml/s pre-operation to 18.8 ± 6.7 ml/s at 12 years post-operation.

Conclusions

TVT is an effective long-term treatment for SUI, although the cure rate may decrease with time. A low VLPP was predictive of SUI recurrence, and patients showing no OAB symptoms tended to be younger.     

Tension‐free vaginal tape for stress urinary incontinence: Is there a learning curve?

AIM: To assess the learning curve characteristics of the first 30 tension-free vaginal tape (TVT) procedures carried out in our medical center and to evaluate its safety and short-term effectiveness. METHODS: A total of 30 incontinent women with urodynamically proven SUI were enrolled. None had undergone any previous anti-incontinence procedure. All were operated on by one surgeon, in accordance with the technique described by Ulmsten et al. in 1996. Mean follow-up was 11.4+/- 3.6 months (range, 5-17 months). RESULTS: Five (17%) bladder perforations occurred at the beginning of the study, due to inadvertent insertion of the applicator. All perforations were identified by intraoperative cystoscopy. Five other patients (17%) had increased intraoperative bleeding (>200 mL) necessitating vaginal tamponade. Blood transfusions were not required. Eight (27%) patients had immediate postoperative voiding difficulties, necessitating catheterization for 2-10 days, but none needed long-term catheterization. There was no local infection or rejection of the Prolene tape was found. All patients were subjectively cured of their stress incontinence; however, urodynamic evaluation revealed "asymptomatic genuine stress incontinence" in one patient. Sixteen of 21 patients (80%) with preoperative urge syndrome, had persistent postoperative symptoms. No patient developed de novo urge incontinence. CONCLUSION: The TVT operation is a new, minimally invasive surgical procedure with excellent short- and medium-term cure rates. However, there is a definite learning curve, and we believe that the operation should only be performed by experienced surgeons.     

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.     

无张力阴道悬吊系统TVT-S治疗女性压力性尿失禁临床分析

目的 探讨第三代无张力阴道悬吊系统TVT-S治疗女性压力性尿失禁的适应证和疗效.方法 回顾性分析采用TVT-S术式治疗女性压力性尿失禁27例患者的资料.年龄25～69岁,平均51岁;病程1～20年,平均7年,既往曾行阴道前壁折叠术1例.根据美国妇产科学会POP-Q分级系统评价,Aa为-2～-1 cm,棉签试验尿道夹角＞60°,临床症状评估均为Ⅱ度.27例术前尿动力学检查膀胱顺应性正常,最大尿道闭合压(mUCP)25～60 cm H2O(1 cm H2O=0.098 kPa),平均40 cm H2O,腹压漏尿点压(VLPP)均＞60 cm H2O.混合性尿失禁1例,单纯型压力性尿失禁26例.观察指标包括手术时间、术后并发症,随访患者的疗效及生活质量.结果 局麻下手术,行U形手术4例(MUCP＜30 cm H2O),H形手术23例.手术时间6～15 min,平均8 min.术中失血量少,无尿道及膀胱损伤.术后留置尿管时间平均1 d.术后随访3～15个月,平均8.7个月,26例无需尿垫达到临床治愈,1例混合性尿失禁患者急迫性尿失禁症状改善.I-QOL问卷调查患者生活质量评价良好.25例(93%)患者对术后尿失禁症状改善表示满意,且术前尿失禁症状较重者满意度更高.结论 TVT-S是一种治疗女性压力性尿失禁安全有效且并发症低的微创术式,适合于膀胱顺应性正常、最大尿道闭合压正常、尿道移动度较大的患者,部分高龄或尿道压力较低者建议行U形TVT-S或TVT术.

Abstract：

Objective To evaluate the effectiveness and indications of a new minimally invasive surgical procedure,the tension-free vaginal tape-SECUR (TVT-S),in the treatment of female stress urinary incontinence (SUI). Methods Twenty-seven consecutive women with stress urinary incontinence underwent the procedure under local anesthesia.The mean age of the study group was 51 (range 25-69)years,average disease duration was 7 (1-20) years.In one case,repair of pelvic floor defects had been made previously.According to the pelvic organ prolapse quantitive(POP-Q) (American College of Obstetrics and Gynecology),the Aa＞-1 cm.Swab tests have shown that the angle of urethra Was greater than 60 degrees,while the evaluation of clinical symptoms were grade Ⅱ.The urodynamie test preoperatively of 27 cases display that bladder compliance was normal,mean maximum urethral closure pressure was 40cm H2O(25-60 cm H2O),and VLPP was greater than 60 cm H2O.Minimum follow up was three months (range 3-15 months).The pre-operative maximal urethral cloSHre pressure (MUCP) of all patients was above 30 cm H2O.Ninety-six percent of patients had pure USI,one patient had mixed urodynamic incontinence (MUI).Collection of the data included operative time a well as pre-and post-operative complications.Patients were post-operatively assessed by a validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire which was completed by all patients at least three months after surgery. Results All patients who underwent the procedure were under local anesthesia.Of these patients,4 cases (MUCP＜30 cm H2O) underwent TVT-S with "U" position while the other 23 underwent TVT-S with "Hammock" position.The mean operation time was 8 minutes (range 6-15 min) and blood loss during operation was about 10 ml.There were no urethral and bladder injuries during the procedure.Postoperative indwelling duration was 0-1 day.After follow-up,26 patients were cured without pad usage and 1 with mixed UI had prominent improvement in urgency incontinence symptoms.The quality of life was also improved significantly.93 % patients were satisfied with the postoperative improvement in urinary incontinence symptoms,and the more severe preoperative symptoms the higher satisfaction rate postoperatively. Conclusions TVT-S iS a safe,effective and minimally invasive procedure for SUI with less complication.The patients with normal bladder compliance and MUCP,urethral hypermobility are indicated for this surgery,some elderly patients or patients with low urethral pressure were proposed to undergo "U" position TVT-S or TVT.     

Results and complications of TVT procedure in the surgical treatment of female stress incontinence

ObjetivesTo evaluate the efficacy and safety of Tension-free vaginal tape (TVT) for treatment of female stress urinary incontinence (SUI).To determine the mid-term outcome of TVT performed during other pelvic floor reconstructive procedures.Patients and methods100 women with SUI undergoing TVT procedure under spinal anesthesia from January 2000 to 1November 2002 were studied.76 women were treated with TVT alone. 24 patients were treated with TVT and pelvic floor reconstruction: we repaired 24 cystoceles grade II-III, 3 rectoceles and 4 concomitant vaginal histerectomies.ResultsMean age was 49,3 years (range 35-78). Mean parity: 2 (range 0-6) and mean operative time was 38 minutes (range 20 to 50). The postoperative hospital stay was 24 hours for women treated with TVT alone. Only 1 patient (1%) need bladder catheterization during 7 days due to urinary retention.Mean followup was 18 months (range 12-48). Objetive cure rate was 95%. In our study the rate of de novo post-operative urge symptoms (16%) was the most frequent complication. Bladder injury was the most grave problem and it happened in 1 patient (1%).ConclusionThe results confirm the feasibility and safety of TVT for treatment of SUI. Moreover, TVT procedure is economical and efectiveness.Pelvic floor defects, benign uterine disorders and SUI can be safely treated with TVT and vaginal procedures during the same surgical time.