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.     

One-year results of a prospective randomized, evaluator-blinded, multicenter study comparing TVT and TVT Secur

Introduction and hypothesis

The aim of this prospective randomized multicenter study was to compare retropubic tension-free vaginal tape (TVT) with TVT Secur in terms of efficacy and safety.

Methods

We set out to enrol 280 stress urinary incontinent (SUI) women with a half-time interim analysis of short-term cure and adverse events. The short-term results have previously been published. Of the133 randomized women, 125 underwent surgery, and 121 (TVT n?=?61, TVT Secur n?=?60) were available for follow-up 1 year postsurgery.

Results

No significant differences were found between groups regarding demographics or incontinence grade. One year after surgery, both subjective and objective cure rates were significantly lower for TVT Secur than for TVT (subjective cure: TVT 98 %, TVT Secur 80 %, p?=?0.03; objective cure: TVT 94 %, TVT Secur 71 % for cough test, p?=?0.01; TVT 76 %, TVT Secur 58 % for pad test, p?=?0.05 ). Three major complications occurred in the TVT Secur group: one tape erosion into the urethra, one tape inadvertently placed into the bladder, and one immediate postoperative bleeding due to injury to the corona mortis. No major complications occurred in the TVT group. No significant differences were found between groups regarding peroperative bleeding, hospital stay, urge symptoms, residual urinary volume, subjective bladder emptying problems, postoperative urinary tract infections, and minor complications. The TVT Secur group used more antimuscarine medication after surgery than the TVT group (p?=?0.03). Median time for surgery was 13 and 22 min for TVT Secur and TVT, respectively (p?<?0.0001).

Conclusion

The TVT Secur procedure had significantly inferior subjective and objective cure rates compared with the retropubic TVT procedure. Three serious adverse events occurred in the TVT Secur group. We therefore discourage further use of TVT Secur.     

Holmium laser treatment of a vesical calculus secondary to TVT procedure

A case of vesical calculus is being presented as a complication of TVT procedure done for severe stress incontinence in an elderly lady. The patient, who presented with obstructive and irritative lower urinary tract symptoms, needed an indwelling catheter. Non-enhanced CT scan of abdomen confirmed an intraluminal calcific density in the anterior wall of urinary bladder just left of midline. On cystoscopy, a blue-colored polypropylene mesh of the TVT was visible at the ends of this calculus, holding it to the anterior vesical wall. Holmium laser was used to disintegrate the ends of the mesh deep in the submucosa of the urinary bladder. To our knowledge, this is a unique case of calculus forming near the dome of bladder over a TVT mesh presenting 3 years post-operatively and treated with holmium laser.     

Comparison of laparoscopic Burch and tension-free vaginal tape in treating stress urinary incontinence in obese patients.

OBJECTIVE: To compare the efficacy and safety of the tension-free vaginal tape (TVT) and laparoscopic Burch procedures in treating genuine stress urinary incontinence in obese patients. METHODS: This was a retrospective evaluation of 91 consecutive cases of TVT alone or TVT combined with other procedures from April 1999 through March 2000 and 51 consecutive cases of the laparoscopic Burch procedure from January 1998 through February 1999. All procedures were performed in a private practice and community hospitals in the midwest. One hundred forty-two women (ages 34 to 79) with stress urinary incontinence documented by clinical examination and preoperative cystometric and urodynamic evaluation were included in the study. They were also divided into 5 groups based on their body mass index (BMI): NL (normal-BMI < 25), OW (overweight-BMI 25 to 29), OBI (obesity I-BMI 30 to 34), OBII (obesity II-BMI 35 to 39), OBIII (obesity III-BMI > 40). In the TVT group, 66% were obese (OBI-21, OBII-17. OBIII-22) versus 36% in the laparoscopic Burch (OBI-13, OBII-5) group. RESULTS: All TVT patients remain cured or symptoms improved in their genuine stress urinary incontinence, which favorably compares with the laparoscopic Burch procedure after 1 year. Operating time for the TVT portion ranged from 18 to 40 minutes. The laparoscopic Burch procedure in general took over 1 hour. No bladder, bowel, or vascular injuries have occurred in the TVT group. Superficial suprapubic ecchymoses have occurred in the TVT group occasionally but required no intervention. The average length of stay was 1 day; TVT-only patients usually were released on the same day. Ninety percent of patients were voiding normally by postoperative day 7. Most of the patients with continued urinary retention had had combined procedures. CONCLUSIONS: This preliminary study indicates that TVT is a safer, more effective, and easier minimally invasive surgery for genuine stress urinary incontinence regardless of the patients' BMI and favorably compares with the laparoscopic Burch procedure, which requires advanced surgical skills.     

A magnetic resonance imaging-based study of retropubic haematoma after sling procedures: preliminary findings

OBJECTIVE: To determine, using magnetic resonance imaging (MRI), the incidence of retropubic haematoma and any associated clinically significant effects after a xenograft (porcine dermis) sling (XS) or the tension-free vaginal tape (TVT) procedure. PATIENTS AND METHODS: Between October 2003 and March 2004, 24 consecutive patients presenting with stress urinary incontinence (SUI) were enrolled in this prospective study; 12 each underwent an XS or TVT procedure. A vaginal balloon pack was used for only 3 h after XS and not after TVT. All patients had pelvic MRI 6-8 h after surgery. The primary outcome measure was the incidence and distribution of retropubic haematoma after each sling technique. Secondary outcome measures included the interval to the first three spontaneous voids, the bladder emptying efficiency of the first three voids, a visual analogue scale pain score at 24 h after surgery, and the short-term (6-month) cure rate for SUI. RESULTS: Overall, six (25%) patients (four XS and two TVT) developed a retropubic haematoma. Most commonly, they spread along the right paravesico-urethral space between the right half of the levator ani and the bladder neck. Patients with large haematomas took significantly longer to void (median 14.5 vs 6.0 h, P = 0.048). There was no difference in pain score in patients with or with no haematoma. None of the patients had clinically detectable haematomas in the suprapubic wound. All six patients with haematomas were cured or improved at the 6-month follow-up. CONCLUSIONS: MRI is a useful noninvasive method for detecting retropubic haematomas soon after surgery. There was a surprisingly high incidence of retropubic haematomas, especially after the XS procedure. Retropubic haematomas may influence postoperative voiding efficiency.     

Sling removal after the Vesica sling and tension-free vaginal tape (TVT) procedures

PURPOSE: We describe our experience of sling removal performed after either the Vesica sling procedure (due to vaginal erosion or at the time of reoperation for recurrent stress incontinence) or the tension-free vaginal tape (TVT) procedure (due to persistent urinary retention). MATERIALS AND METHODS: From May 1997 to December 2002, we performed 19 Vesica sling procedures and 66 TVT procedures for the treatment of urodynamic stress incontinence. In the former procedures, four patients (21%) developed vaginal erosion and underwent total or partial removal of sling material (Hemashield made from bovine-collagen-injected woven polyester). In another three patients, stress incontinence recurred 2-4 years after the Vesica sling procedure, and they underwent total sling removal and the TVT procedure. Before using the urethral pull-down process (UPDP) in TVT procedures, 2 out of 23 patients (8.7%) developed persistent urinary retention and underwent either sling release alone or partial sling removal concomitant with a second TVT procedure. After the introduction of the UPDP, no patient developed urinary retention. RESULTS: Three patients in whom total sling removal was performed due to vaginal erosion after a Vesica sling procedure developed recurrent stress incontinence. One patient who underwent partial sling removal remained continent, but vaginal erosion recurred 2 years later. Patients who had total sling removal and TVT procedures due to recurrent stress incontinence after Vesica sling procedure became continent with an uneventful postoperative course. One patient who underwent transvaginal release of TVT tape (polypropylene mesh) due to urinary retention after the TVT procedure developed recurrent stress incontinence, and the other who underwent partial removal of TVT tape and a second TVT procedure had resolution of urinary retention without recurrence of stress incontinence. CONCLUSION: Prompt and total sling removal should be recommended for vaginal erosion after the Vesica sling procedure. In patients with urinary retention after the TVT procedure, partial removal of TVT tape and a second TVT procedure using the UPDP to prevent overtightness may be a preferable choice to attain both continence and resolution of urinary retention.     

Long-term results of tension-free vaginal tape for female urinary incontinence: Follow up over 6 years

OBJECTIVE: To describe the long-term outcome of using tension-free vaginal tape (TVT) with and without associated procedures. METHODS: A questionnaire was mailed to a population of 61 women who had undergone TVT surgery more than 6 years ago. Of this population, 41 (80%) had suffered from stress urinary incontinence (SUI). The questionnaire included questions about urinary symptoms, satisfaction and quality of life. The questionnaire was answered by 51 of the 61 women. RESULTS: Mean follow up was 83 months. The women with SUI had a persistent cure rate of 80% with a satisfaction rate of 97%. The cure rate after 6 years was 37% in women with mixed incontinence. Concomitant hysterectomy (relative risks = 0.87) and body mass index (BMI) do not alter the long-term results of TVT procedure. Peroperative bladder injury is not associated with an increased risk of long-term lower urinary tract symptoms (LUTS) or with a decreased satisfaction rate (relative risks = 0.85). CONCLUSIONS: Concomitant hysterectomy, increased BMI and bladder injury do not alter good long-term results of TVT.     

Tension-free vaginal tape evaluated using patient self-reports and urodynamic testing--a two-year follow-up

OBJECTIVE: Urinary incontinence entails both reduced quality of life for many women and considerable public expense. Compared with other methods aimed at alleviating incontinence, tension-free vaginal tape (TVT) is minimally invasive, can be performed under local anaesthesia and results in less morbidity and shorter hospitalization. The present study was carried out to evaluate early and late complications and as a 2-year follow-up after surgery. MATERIAL AND METHODS: In 1996-98, 75 women underwent TVT sling plasty; mean time for surgery was 39 min and for hospitalization 24 h. The procedure caused bladder perforation in 3 women, but this was detected by cystoscopy and immediately corrected. Postoperative retention occurred in 9 patients but was transient. RESULTS: After surgery 80% were cured, 9% showed improvement and 11% were failures. Two women exhibited vaginal erosion, and one of these had previously undergone radiation therapy. One sling caused obstruction and had to be cut. Improvements included less impact on social and physical activities and mental status and significant reduction of voiding frequency, leakage episodes and pad use. CONCLUSIONS: The TVT technique seems to provide results comparable with those obtained with Burch colposuspension, but it entails less risk of obstruction than previous slings techniques because it causes no compression of the urethra. TVT is effective in women with genuine stress incontinence due to urethral hypermobility and in elderly women with sphincter incompetence, although the outcome is better in the former.     

Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders

STUDY DESIGN: Retrospective. OBJECTIVE: To evaluate the safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress incontinence in females with neuropathic bladders. SETTING: London Spinal Injuries Unit, Stanmore & Institute of Urology, London, UK. METHODS: Twelve women (mean age 53.3 years; range 41-80 years) with neuropathic bladder dysfunction and stress urinary incontinence were treated with tension-free vaginal tape (TVT) between November 1997 and December 2000. The group consisted of women with: (i) traumatic spinal cord injuries (n=3); (ii) post lumbar spinal surgery (n=6); (iii) spinal stenosis (n=3). Four of the 12 patients had previously failed surgery for stress incontinence. All patients underwent pre- and post-TVT evaluation with video-urodynamic studies. RESULTS: Mean follow-up was 27.1 months (range 17-54 months). Three patients were voiding spontaneously (stress voiding) before surgery and continued to do so post-operatively. The remaining 9 were performing clean intermittent self-catheterisation before the insertion of TVT and continued to do so after the surgery. At follow up 10 patients (83.3%) were dry. The procedure failed in one patient and the other complained of mild leakage, but she reported a decrease in the number of pads used. One patient developed detrusor hyperreflexia on post-operative video-urodynamics but there was no evidence of stress incontinence. One patient had a bladder perforation on insertion of TVT, managed successfully with extended use of a urethral catheter post-operatively. Three patients developed post-operative urinary tract infection successfully treated with oral antibiotics. CONCLUSIONS: Tension-free vaginal tape insertion is minimally invasive, safe and effective for the treatment of stress incontinence in females with bladder neuropathy with intrinsic sphincter deficiency. Previous surgery for incontinence did not affect post-operative complications or outcome.     

The correlation between preoperative voiding mechanism and surgical outcome of the tension-free vaginal tape procedure,with reference to quality of life

OBJECTIVES: To determine whether the surgical outcome of the tension-free vaginal tape (TVT) procedure differs in patients with dysfunctional voiding (DV) or normal voiding. PATIENTS AND METHODS: The voiding mechanism and surgical efficacy of the TVT procedure were analysed retrospectively by reviewing the charts of 79 consecutive women treated over 2 years. Based on their initial voiding mechanism, the patients were divided into two groups, with or without DV. The King's Health Questionnaire was used to evaluate the women's quality of life both before and 1 year after surgery. RESULTS: The change in free maximum urinary flow rate (Qmax) after surgery differed significantly between the groups (P = 0.001). Moreover, both before and after surgery, the free Qmax was significantly lower (P = 0.019 and 0.001, respectively), and the detrusor pressure at Qmax (both P < 0.001) and urethral resistance (P = 0.036 and 0.027, respectively) significantly higher in the group with DV. The subjective outcome measure showed that the cure rates were not significantly different in the two groups (P = 0.173), but the objective outcome measure showed a significant difference (P = 0.025). Analysis of the total scores for all domains showed that significantly more women improved by> 25% in the group without than in those with DV (P = 0.016). CONCLUSIONS: The objective cure rate of the group without DV undergoing the TVT procedure was significantly higher than in those with DV. In addition, subjective measures assessed by the disease-specific quality-of-life questionnaire indicated that the group without DV had a better quality of life than those with DV.     

Results of the tension-free vaginal tape technique in the elderly

OBJECTIVES: To assess the results of the Tension-Free Vaginal Tape (TVT) technique for the treatment of stress urinary incontinence (SUI) in the elderly. PATIENTS AND METHODS: Between March 1998 and February 2001, 76 consecutive women more than 70 years old (median 76) and presenting with SUI were operated with the TVT technique. 28.9% (22/76) of the patients had previous surgery for SUI. 31% (24/76) of the patients had an overactive bladder and 4 patients had detrusor instability controlled by anticholinergic therapy. All patients had preoperative multichanel urodynamic evaluation. RESULTS: No serious complication was noted intra- or postoperatively. At a mean follow up of 24.6 months (range 16-49 months), 67% of the patients were cured (51/76). Among the failures, 10 patients (13.7%) had persistent SUI, 14 patients (18.4%) had urge incontinence and 2 patients were lost to follow up. De novo urgency without incontinence was noticed in 21% of the patients but preoperative urgency symptoms were cured in 46% of the patients. Overall 82% of the patients were satisfied with the result of the surgery, 14% considered the result as incomplete and 4% considered they were worsened by surgery. CONCLUSION: The TVT procedure is safe and efficient to treat SUI in the elderly population even if the rate of de novo urgency appeared to be significant.     

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.     

Tension-free vaginal tape procedure for the treatment of female stress urinary incontinence: long-term results

PURPOSE: The tension-free transvaginal tape (TVT) procedure has apparently become the most popular technique for genuine stress urinary incontinence (GSUI). Long-term followup data on the outcome of the procedure are sparse. We evaluated the long-term results of TVT for treating women with GSUI. MATERIALS AND METHODS: We performed a retrospective analysis of the records of 55 patients 37 to 83 years old (mean age 63.4) with GSUI, for which they underwent the TVT procedure at our department as of December 1999. RESULTS: Of the 52 patients who were followed a mean of 55 months (range 48 to 65) 41 (78.9%) were dry. There were 4 intraoperative complication (7.3%), including bladder injury in 3 patients and urethral injury in 1. None required surgical re-intervention. Urgency was reported in 6 women (11.5%). There were 5 postoperative tape related complications (9.6%), consisting of bladder erosion in 1 woman, vaginal erosion in 2 and an obstructed urethra in 2. Four of these 5 women underwent corrective surgery, after which all remained dry. CONCLUSIONS: TVT is a safe and effective procedure for female stress urinary incontinence with an enduring, high success rate. There is a significant rate of intraoperative complications, which do not cause further problems when identified and treated during surgery. One must be alert to the significant rate of postoperative complications that usually require repeat surgery, which is relatively simple and causes practically no long-term morbidity. It also does not influence the continence rate in most cases.     

Urinary stress incontinence treatment with Remeex in a patient with epispadias: a case report

Epispadias is a rare condition in women. A postmenopausal 53-year-old woman with a known problem of epispadias came to our outpatient clinic complaining of persistent severe urinary stress incontinence without overactive bladder symptoms. She had previously undergone an inefficacious tension-free vaginal tape (TVT) procedure in another institution. We implanted a Remeex (Mechanic External Regulation) device without applying any tension to the sling. Two tape regulations were performed the day after surgery and 2 months later to gain continence. At 13 months of follow up, this woman was asymptomatic and satisfied. As documented by this case here, the Remeex procedure is particularly suitable in selected high-risk patients where TVT and TVT live slings are less effective.     

Effectiveness of the TVT procedure as a repeat mid-urethra operation for treatment of stress incontinence

Introduction and hypotheses  The aim was to evaluate the long-term (5 years) effect of performing a retropubic tension-free vaginal tape (TVT) operation after a prior failed mid-urethra sling procedure and try to identify reasons for failure of the primary operation. Methods  We identified 26 women to whom a repeat mid-urethra sling procedure (using the TVT Gynecare device) had been performed. Both the primary and repeat operations were retropubic procedures. Four different tape materials had been utilized in the primary procedure. Results  Twenty women (77%) of the identified 26 women participated in the study. Seventy-five percent of the women were cured or significantly improved after the repeat TVT procedure. Reasons for failure of the primary procedure were grouped as follows: inadequate tape material (four out of 20), inadequate surgical technique (six out of 20), patients' medical condition (four out of 20), and unrecognized reasons (six out of 20). Conclusions  A retropubic mid-urethra sling operation can be considered after failed mid-urethra sling surgery.     

Tension-free vaginal tape (TVT) in morbidly obese patients with severe urodynamic stress incontinence as last option treatment

OBJECTIVES: To determine the safety and efficacy of tension-free vaginal tape (TVT) in morbidly obese women with severe urodynamic stress incontinence (USI) as last option treatment. METHODS: Thirty-one patients with body mass index (BMI) >40 kg/m2, who had undergone the TVT procedure for urodynamically-confirmed USI were matched with 52 patients with BMI <30 kg/m2 who underwent the same procedure. BMI was calculated at the time of the surgery. Patients' characteristics and surgical data, complications and cure rates were analyzed for both groups. RESULTS: After a mean follow-up of 18.5 (range: 12-24) months the continence rates were 87% and 92% for morbidly obese women and control group, respectively (p = 0.103). No serious intraoperative complications were noted in both groups. However, the early postoperative complications were significantly higher (p < 0.05) in morbidly obese patients. In 4 patients from both group long term postoperative catheterization was necessary for 4 weeks. In one patient (2%) from the control group dilatation of urethra took place. No defect in healing or rejection of the tape occurred. CONCLUSIONS: TVT is a minimal invasive and safe procedure for morbidly obese patients suffering from severe USI with good outcome. Preoperative morbid obesity does not seem to be a risk factor for failure of this procedure.     

TVT-obturator: short-term data on an operative procedure for the cure of female stress urinary incontinence performed on 300 patients

OBJECTIVES: To evaluate the short-term therapeutic results of a novel minimally invasive anti-incontinence operative procedure-the tension-free vaginal tape (TVT)-obturator. METHODS: With this prospective, observational, and consecutive patient series, TVT-obturator surgery was performed, according to de Leval (2003), by the same surgeon on 300 patients with urodynamically proven stress urinary incontinence. Follow-up lasted 4-24 mo. RESULTS: The demographic and therapeutic aspects of the patient group data were evaluated. The TVT-obturator required neither bladder catheterization nor intraoperative diagnostic cystoscopy. Half of the 18 (6%) patients with postoperative voiding difficulties had postoperative urethral bladder catheterization for 1-4 d, whereas the other 9 patients underwent a tape loosening procedure in theater under anesthesia. The early therapeutic failure rate for the TVT-obturator procedure was 2.7% (8 patients). Six of the latter patients underwent an interval TVT operation with satisfactory results. Neither bowel nor urethral injuries were recorded, and no evidence of bladder penetration was observed. With the TVT-obturator, no intraoperative bleedings, postoperative field infections, or postoperative pelvic floor relaxations were noted. CONCLUSIONS: Use of the TVT-obturator, a novel midurethral sling, seems to reduce the incidence of some of the operative complications associated with the TVT, primarily bladder penetration and postoperative outlet obstruction. The early therapeutic results and the cost-effectiveness of the novel TVT-obturator appear similar to those reported for common TVT surgery. However, long-term comparative data collection will be required to enable drawing solid conclusions regarding the appropriate position of this operative technique within the spectrum of anti-incontinence operations.     

Impact of tension‐free vaginal tape procedure on dysfunctional voiding in women with stress urinary incontinence

Objectives: To determine the prevalence of dysfunctional voiding (DV) in female stress urinary incontinence (SUI) and its modification after tension‐free vaginal tape (TVT) procedure. Methods: Three hundred and sixty women with SUI were enrolled and underwent urodynamics from 2002 to 2008. DV was determined when non‐neurogenic detrusor‐sphincter dyssynergia occurred during voluntary voiding. It was further quantitatively analyzed using the tense/loose value, a parameter derived from external anal sphincter electromyogram. The distribution of other urodynamic variables was also evaluated. One hundred and fifty patients underwent the TVT procedure and forty of them were studied with urodynamics after surgery during follow up. Results: Overall, DV was diagnosed in ninety‐nine patients, with a prevalence of 27.5%. The functional profile length in SUI women with DV was significantly shorter than that in SUI women without DV (3.13 ± 0.76 vs 3.32 ± 0.65, P = 0.017). After the TVT procedure, the recovery of SUI between cases with and without DV showed no significant difference. The rate of DV state change after the surgery, namely from with to without DV or from without to with DV, significantly differed between the female patients with and without DV (66.7% vs 3.6%, P < 0.05) during follow up. The DV improved after the surgery in SUI women with DV. Conclusions: DV might represent a coexistent finding in women with SUI. The main difference of women with SUI and DV, as compared with those without DV, is a shortened functional profile length. In such cases, TVT procedure can improve DV along with the treatment of SUI.     

The role of interventional radiology in the management of blunt renal injury: a practical protocol

OBJECTIVE: The purpose of this study was to evaluate the efficacy of a protocol designed to minimize the need for surgery in the management of severe blunt renal injury. METHODS: Forty-six of 752 trauma patients had evidence of renal injury on computed tomographic (CT) scan. Two patients required emergency laparotomy, and the remaining 44 patients were classified by CT scan grade using the American Association for the Surgery of Trauma classification system. Patients with CT scan grade 3 or over underwent renal angiography. RESULTS: Twenty-one patients had a high-grade injury on CT scan (> or =3). Eight had angiographic evidence of extravasation from renal arterial branches and underwent transarterial embolization. One patient with a grade 5 injury had extravasation from a main renal vein and underwent immediate laparotomy. This was the only patient who required surgery for renal injury. CONCLUSION: Surgery can be avoided in most cases of blunt renal injury. Hemodynamic instability and injury to main renal veins remain indications for surgical exploration.     

Complications of tension-free vaginal tape surgery: a multi-institutional review

OBJECTIVE: To analyse the complications of tension-free vaginal tape (TVT) surgery, a minimally invasive alternative for treating patients with stress urinary incontinence (SUI), at six institutions, and to review the management of these complications and their effect on patient outcome. PATIENTS AND METHODS: In all, 241 patients who had a TVT procedure by six urologists at six hospitals (two university and four community) were reviewed retrospectively by the same urologist. Complications during and after surgery, and their management, were analysed. RESULTS: Complications during surgery included bladder perforation in 48 patients (5.8%) and blood loss > 500 mL in 16 (2.5%). Immediate complications after surgery were urinary retention (>24 h after) in 47 patients (19.7%), pelvic haematoma in four (1.9%) and suprapubic wound infection in one (0.4%). Of the 47 patients in retention, 32 were in retention for <48 h and treated with an indwelling catheter. The 15 remaining patients were treated with an indwelling catheter (one) or clean intermittent catheterization for a mean of 22 days. To correct the retention the TVT was released in seven patients and the tape sectioned in three. Late complications were de novo urgency, persistent suprapubic discomfort and intravaginal tape erosion in 36 (15%), 18 (7.5%) and one (0.4%) patient, respectively. Most of these complications resolved with observation and medical management, but intravaginal tape erosion required partial resection of the tape with closure and repair of the vaginal mucosa. CONCLUSIONS: The present TVT complication rates were slightly higher than reported previously. This multi-institutional review in both academic and community hospitals may better reflect the morbidity of TVT insertion in clinical practice. TVT is a highly effective, minimally invasive method for treating SUI. A stricter definition of each complication and a better understanding of the mechanism of these complications may further improve the surgical outcome and decrease patient morbidity.