Effect of tension-free vaginal tape position on the resolution of irritative bladder symptoms in women with mixed incontinence

The aim of this study was to determine whether the position of the tension-free vaginal tape (TVT) has an effect on the resolution of irritative symptoms in women undergoing the TVT operation. Initial audit suggested that more distally placed tapes were more likely to result in the resolution of irritative symptoms. An appropriately powered study was designed to test this theory. Seventy-seven women with urodynamic evidence of detrusor overactivity and urodynamic stress incontinence underwent a transperineal ultrasound scan to ascertain the position of the tape after a TVT. The tape was categorised as proximal, middle or distal urethra. The resolution of irritative symptoms was assessed compared to the TVT position. Forty-five women had distal tapes, 30 had mid-urethral tapes and two had proximal tapes. Women with the TVT placed on the distal urethra were no more likely to experience resolution of their irritative symptoms than women with tapes on the mid-urethra (p  > 0.05). Placement of the TVT on any one part of the urethra is not more likely to result in resolution of irritative bladder symptoms.     

Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT,TVT and TVT-O)

The aim of this study was to compare ultrasonographic findings on tape position, angulation and mobility following three surgical anti-incontinence procedures (trans-obturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape obturator (TVT-O)) and to correlate these data with clinical signs of cures and failures and de novo voiding disorders. In this prospective study, vesicourethral static and dynamic analysis of 81 patients (30 TOT, 28 TVT, 23 TVT-O) were evaluated using introital ultrasonography. Width, position and appearance of the tape were similar in all three groups, i.e. like a "V" at rest, round angulation on Valsalva and closed angulation at maximum retaining. Moreover, closer angulation on Valsalva was associated with voiding disorders. Closer angulation at retaining was associated with de novo urge incontinence. Larger angulation of the tape at rest appeared to be significantly associated with recurrent stress incontinence. Ultrasonography could a be useful tool assessing anti-incontinence procedures and investigating post-operative voiding disorders.     

TVT及TVT-O治疗女性压力性尿失禁疗效的Meta分析

目的 评估无张力尿道悬吊带术(TVT)及无张力尿道吊带术-闭孔系统(TVT-O)治疗压力性尿失禁(SUI)的疗效.方法 以"TVT,TVT-O,TOT,SUI,RCT"及"无张力尿道中段吊带术,经闭孔无张力尿道中段吊带术,压力性尿失禁"等为检索词,在MEDLINE,PUBMED,EMBASE,Google Scholar,CNKI,万方数据库检索2001年1月至2007年3月,国内外公开发表的中英文关于TVT及TVT-O手术疗效及其并发症的研究文献,选取其中病例数＞30例的随机对照实验进行Meta综合定量分析,根据固定效应模型和随机效应模型计算结果的一致程度及失效安全系数进行敏感性分析.结果共有6篇文献入选,TVT及TVT-O术后1～17个月的疗效差异无统计学意义(OR=0.67;95%CI 0.40,1.13).TVT-O术膀胱损伤(OR=0.15;95% CI 0.03,0.66)的发生率低于TVT,而术后疼痛(OR=8.61;95% CI 3.03,24.52)的发生率高于TVT,其他并发症如术后尿急(OR=1.16;95% CI 0.54,2.47)、尿潴留(OR=0.54;95% CI 0.24,1.20)、尿路感染(OR=1.07;95% CI 0.61,1.87)的发生率均差异无统计学意义.结论 TVT和TVT-O两种术式的疗效相近,而术后并发症,TVT-O组未报道膀胱穿孔的发生,但术后疼痛多见,其他并发症的发生率没有明显差异.     

Tension-free vaginal tape sling for recurrent stress incontinence after transobturator tape sling failure

The transobturator tape (TOT) sling is a new minimally invasive technique to treat stress urinary incontinence (SUI). Short-term follow-up studies show high success rates; however, as with any surgical treatment of SUI, failures are known to occur. The treatment of recurrent or persistent stress urinary incontinence after a TOT sling is therefore a new dilemma as well. In this paper, we describe the successful use of a retropubic tension-free vaginal tape (TVT) sling in five patients after failed TOT sling. We present case series of five patients who had TOT slings placed for stress incontinence that failed and subsequently had TVT slings placed for persistent SUI. The TVT slings were placed under local/regional anesthesia without removal of the TOT sling. Retrospective chart review of office and hospital charts was completed, and both objective and subjective data were collected. Five patients had TVT slings placed 6–30 weeks after early failure of TOT slings that were placed for stress urinary incontinence. Postoperatively, all patients with urodynamic testing showed evidence of intrinsic sphincter deficiency; however, all maintained urethral mobility of 30°. All five patients had successful treatment of their incontinence with the retropubic tension-free sling procedure with a mean follow-up of 17 months. Recurrent or persistent stress urinary incontinence after TOT sling may be treated with TVT sling without removal of the TOT sling. Further studies with larger numbers and longer-term follow-up is warranted.     

Female sexual function following surgery for stress urinary incontinence: tension-free vaginal versus transobturator tape procedure

The aim of this study was to compare sexual function outcome following tension-free vaginal (TVT) versus transobturator tape (TOT) for stress urinary incontinence (SUI). All women who underwent TVT or TOT procedures for SUI with no concomitant prolapse repair between January 2002 and July 2007 were sent a retrospective pre-post questionnaire. Eighty-one and 64 women were sexually active before and after TVT and TOT procedures, respectively. Sexual function outcome did not differ pre- and postoperatively for the TVT and TOT groups, and postoperatively between the two groups. Responders reported an improvement of intercourse satisfaction in 23 (29.5%) and 21 (32.9%) cases, whereas 14 (17.3%) and eight (12.5%) complained of sexual function deterioration after TVT and TOT procedure, respectively (p = 0.43). This study suggests that anti-incontinence surgery can have a positive and negative outcome on sexual function, with no significant differences between the TVT and TOT procedures.     

Adductor brevis myositis following transobturator tape procedure: a case report and review of the literature

The tension-free vaginal tape (TVT) procedure has long been considered the gold standard for female stress incontinence. Since its introduction in 1995, several other tapes and other minimally invasive treatments have arisen. The transobturator tape (TOT) procedure reproduces the natural suspension of the urethra through the obturator and puborectalis muscles. The TOT procedure was reportedly developed in an effort to prevent bladder perforation associated with the TVT and is generally considered to be a procedure with low morbidity. At our institution, we report the first case of infected mesh with subsequent myositis of adductor muscles after a TOT procedure. To our knowledge, this is the first case reporting this complication, citing specifically that the anatomical structures traversed by the tape, including both muscle and fascia, can be at risk for infection and ultimately require removal of the sling material. We performed a MEDLINE literature search using key words such as “transobturator tape,” “tension free vaginal tape,” and “adductor and obturator complications” to ascertain any reported adductor or obturator muscle complications after placement of TOT. Further, we reviewed the literature to elucidate the consequences of using different mesh materials, specifically their effects on erosion. We reported our case of a 43-year-old woman who presented with right-leg cellulitis and vaginal discharge after having a TOT placed for stress incontinence. Inflammation of the adductor muscles was demonstrated on computed tomography (CT) scan and ultrasound. On physical exam, the mesh had visibly eroded through the vaginal wall. Our patient underwent excision of the mesh material. She ultimately had an uneventful postoperative course and was discharged home in good condition on the postoperative day 2. The mesh material removed was ObTape®. We believe our study is the first case report to discuss the complication of infected adductor muscles and erosion of the tape during post-TOT procedure. After a careful review of the literature, there is no mention of myositis of adductor muscles as a possible complication after the TOT procedure. In fact, the literature has deemed this minimally invasive treatment as a safe and effective procedure with minimal complications including only de novo urgency or urinary retention. The site of infection is of particular interest and can be explained by the course through the anatomical structures that are unique to this particular procedure. Ultimately, the treatment for this procedure was the removal of the mesh along with broad-spectrum antibiotics. In conclusion, the burden falls upon the surgeons to report in a timely fashion both successes and complication for the TOT procedure given their relatively limited experience. This is paramount in determining patients’ risks.     

Sequential comparisons of postoperative urodynamic changes between retropubic and transobturator midurethral tape procedures

Objectives  To sequentially compare the postoperative urodynamic changes in patients with urodynamic stress incontinence (USI) who underwent tension-free vaginal tape (TVT) or transobturator tape (Monarc TOT) procedure. Methods  Between January 2001 and December 2005, 50 consecutive patients with USI who underwent TVT (n = 24) or TOT (n = 26) procedures were studied, and postoperative urodynamic changes were sequentially compared by one-way ANOVA test with Bonferroni’s correction. Results  There were no significant between-group postoperative changes in urodynamic parameters of uroflowmetry, filling and voiding cystometry. However, the TVT group had a higher objective cure rate (100% vs. 69.2%, P = 0.004) by pad test, urethral closure pressure area [40.4 cm² H₂O, 95% confidence interval (CI) = 22.3–58.5 cm² H₂O vs. 3.9 cm² H₂O, 95% CI = −10.9 to 18.7 cm² H₂O, P = 0.036], and continence area (34.4 cm² H₂O, 95% CI = 16.1–52.7 cm² H₂O vs. −3.5 cm² H₂O, 95% CI = −16.7 to 9.8 cm² H₂O, P = 0.001) at 12 months than those of the TOT group. Conclusions  This study demonstrated that tension-free vaginal tape and transobturator tape procedures had no significant difference of impact on bladder voiding and storage functions. However, this study demonstrated that TVT procedure resulted in a higher cure rate with a significantly increased urethral closure pressure area and continence area than did TOT procedure 12 months postoperatively. Thus, TVT procedure might be a better therapeutic choice to achieve continence than TOT.     

Tension-free vaginal tape versus transobturator tape for treatment of stress urinary incontinence: A comparative randomized clinical trial study

ObjectiveThe objective of this study is to evaluate short- and mid-term results of tension-free vaginal tape (TVT) and transobturator tape (TOT) for the treatment of female stress urinary incontinence (SUI) in Imam Reza Academic Hospital.MethodsA total of 100 women with SUI treated using TVT (n = 50) or TOT (n = 50) between March 2008 and October 2010 were included in this prospective randomized clinical trial study. Preoperative workups, including case history, clinical examination, cough test, urodynamic study with abdominal leak point pressure and postvoiding residue measurements, pad test, transvaginal scan, and evaluation with International Consultation on Incontinence Modular Questionnaire–Urinary Incontinence (ICIQ-UI) and International Consultation on Incontinence Modular Questionnaire–Quality of Life (ICIQ-QOL), were performed. During hospitalization, the type of anesthesia, operative time, hospital stay, and catheter indwelling time were recorded. Postoperatively, continence status and subjective patient satisfaction were evaluated using a cough test and in some patients by a pad test also; transvaginal scan and ICIQ-UI and ICIQ-QOL evaluations at 1, 3, 6, 12, and 18 months of follow-up were performed for all patients.ResultsThe mean age was 52.02 ± 7.37 years in the TVT group and 52.27 ± 7.34 years in the TOT group. The rate of complications was similar in both groups. The operative time was 14.50 ± 7.40 and 15.00 ± 7.48 minutes (p = 0.86), hospital stay time 1.56 ± 0.51 and 1.52 ± 0.47 days (p = 0.76), and catheter indwelling time 1.58 ± 0.41 and 1.55 ± 0.47 days (p = 0.651) in the TVT and TOT groups, respectively. At 1, 3, 6, 12, and 18 months after intervention, ICIQ-UI and ICIQ-QOL were completed for all the patients and no significant difference was found between them.ConclusionOur study results showed that TVT and TOT methods have similar efficacy and safety for SUI, although the catheter indwelling time was significantly longer in the TVT group.     

Laparoscopic transvesical removal of erosive mesh after transobturator tape procedure

We have experienced two cases of intravesical transobturator tape (TOT) tape successfully removed by laparoscopic transvesical procedure. Patient 1 was a 67-year-old woman complaining of irritative symptoms of the urinary bladder. In another hospital she had undergone anterior corporrhaphy and a TOT procedure to treat a cystocele and stress urinary incontinence (SUI) 17 months before the initial consultation. A cystoscopy revealed tape extrusion and adherent calculi at the 4 to 5 O'clock position of the bladder neck. After filling the bladder with carbon dioxide, three 5-mm ports were placed in lower abdomen directly into the bladder. The tape extruding from the bladder muscle layer was completely excised, and extirpated with the adherent calculi. The bladder mucosa and muscle layer were continuously sutured using 4-0 Vicryl (Ethicon Inc., Somerville, NJ, USA). The port entry sites were closed under direct vision using 4-0 Vicryl. SUI recurred 15 months later and a second TOT surgery was performed. Neither SUI nor mesh extrusion have been observed during the 18 months following the second TOT. Patient 2 was a 74-year-old woman. She consulted our hospital for the removal of an intravesically extruded tape and adherent calculi. She had undergone a vaginal hysterectomy and TOT surgery for uterine prolapse and SUI at another hospital 3 years before her visit. A cystoscopy revealed tape extrusion and adherent calculi on the right bladder wall. We performed an endoscopic transvesical extirpation of the intravesical foreign bodies in a same manner described below. There has been no recurrent SUI or mesh erosion during the 18-month follow up.     

How does tension-free vaginal tape correct stress incontinence? Investigation by perineal ultrasound

Forty patients who underwent a single tension-free vaginal tape procedure were evaluated by perineal ultrasound both pre- and postoperatively in a prospective observational clinical study. The positions of the tape, bladder neck and urethra were sonographically documented at rest and during Valsalva maneuvers. During Valsalva the tape rotated towards the symphysis in all patients. Postoperative urethral angulation could be demonstrated in 36 of 40 patients. Bladder neck mobility remained unchanged after the tension-free vaginal tape procedure, and 36 of the 40 were dry according to patient questionnaires. Postoperative cough test was negative in all patients. Two points seem to be important for the functioning of the tension-free vaginal tape: a dynamic kinking of the urethra during stress, and the movement of the tape against the symphysis, compressing the tissue between the tape and the symphysis. Mobility of the bladder neck is unaffected by the single tension-free vaginal tape procedure.Abbreviations TVT Tension-free vaginal tape - UVJ Urethrovesical junction Editorial Comment: The authors are to be commended for an interesting study using perineal ultrasound imaging for evaluation of TVT placement and function. The study demonstrates two main functions of the tape: midurethral kinking, and compression of the tape against the symphysis pubis. This agrees with published imaging data and confirms the essentially obstructive function of the TVT.     

Intentional urethral closure with a TVT (tension-free vaginal tape) for intractable urinary incontinence: a preliminary report of three cases

Bladder neck and urethral closure with urinary diversion is offered as a last resort to patients with intractable urinary incontinence. Various techniques have been described to achieve bladder neck and urethral closure. Most of these are associated with either operative morbidity or long-term complications. A modification of the conventional tension-free vaginal tape (TVT) procedure is described. As the name suggests, during the conventional TVT procedure, the tape is inserted relatively without tension in such a manner that the urethra retains its function and post-operative voiding is possible. In the cases described in this short series, the aim was to achieve urethral and bladder neck closure with minimal operative morbidity. This was achieved by inserting the TVT exactly as in a conventional TVT procedure, but the tape was inserted under greater tension than is normally used to ensure continence. A long-term suprapubic catheter was used for urinary diversion. This procedure is simple to perform, is associated with low operative morbidity [Agostini et al., Eur J Obstet Gynecol Reprod Biol, 124(2):237–239, 2006] and results in functional urethral closure. Results suggest that it may be a useful alternative to other bladder neck and urethral closure procedures in selected patients.     

How to advise a woman who wants to get pregnant after a sub-urethral tape placement?

Our objective was to make recommendations for the follow-up of pregnancies and the choice of delivery route for patients becoming pregnant after surgical treatment of stress urinary incontinence (SUI) by tension-free vaginal tape (TVT) or trans-obturator tape (TOT). We performed a retrospective survey on pregnancies after surgical treatment of SUI. Nineteen physicians out of 3,400 contacted reported a total of 20 pregnancies after TVT or TOT. Three patients had recurrent SUI during pregnancy. No major complications of the tape occurred during pregnancy. Ten patients out of 20 delivered vaginally, and nine had a caesarean section. Mean follow-up after delivery was 13.8 months (1 to 52). Recurrence of SUI was observed in 3 of 20 (15%) during pregnancy and in 3 of 18 (16.7%) after delivery. The global rate of recurrence was 4 of 18 (22.2%). Recurrence of SUI was two of ten cases after vaginal delivery (20%) and in one of eight after caesarean section (12.5%; p = 0.58). Vaginal delivery did not increase the risk of recurrence.     

Transobturator tape versus retropubic tension-free vaginal tape for stress urinary incontinence: 5-year safety and effectiveness outcomes following a randomised trial

Introduction and hypothesis

In a randomised trial comparing transobturator tape (TOT) to retropubic tension-free vaginal tape (TVT) for women with stress urinary incontinence (SUI), vaginal examination at 12 months showed that tapes were palpable for 80.0 % of the TOT group versus 26.7 % of the TVT group. We hypothesized that this difference would lead to more women in the TOT group experiencing vaginal mesh erosion or other serious adverse events compared to women in the TVT group 5 years after surgery.

Methods

All participants were invited to join the follow-up study after being randomised to receive TOT or TVT for SUI. Consenting women had a vaginal examination, a pad test for urinary incontinence (UI) and completed Health-related Quality of Life Questionnaires (HRQOL). Women unable to attend the clinic completed questionnaires only. The primary composite outcome incorporated mesh exposure, urinary retention, repeat incontinence surgery and moderate to severe pelvic pain. Assuming 80 % follow-up, our study would have 67 % power to detect a difference in primary outcome (two-sided 5 % level of significance). Comparisons between groups used chi-square tests and t tests.

Results

One hundred and seventy-six (88.4 %) women participated in the 5-year follow-up (83 TOT, 93 TVT). The primary composite outcome occurred in 21.8 % of the TOT and 27.6 % of the TVT groups [difference?=?5.8 %, 95 % confidence interval (CI) ?18.9 % to 7.3 %, p value 0.39)] Vaginal examination found more women with palpable tapes in the TOT versus the TVT group (48.5 % versus 22.4 %, p value 0.001). There were no other significant differences between groups.

Conclusions

Serious adverse events and tape effectiveness did not differ between groups at 5 years. Palpable tape remains a concern for women who receive TOT for treating SUI.

     

MRI visualization of the female pelvis in the plane of the tension-free vaginal tape (TVT) procedure

We evaluated the distances and angles of the major blood vessels from various pelvic structures in the plane of the tension-free vaginal tape (TVT) procedure in 19 pelvic MR imagies. The major blood vessels were the iliofemoral vessels. The mean distance of the left iliofemoral vessels from the midline was 5.7±0.4 cm, and 5.7±0.3 cm for the right vessels. The mean distance of the left sacral tuberosities from the midline was 5.5±0.4 cm, and 5.6±0.3 cm for the right vessels. The angle between the midurethra and the left iliofemoral vessels was 50.6±4.4 cm, and 49.6±4.0 cm for the right. A significant correlation was found between the distance of the right and left iliofemoral vessels from the midline and the distance of right and left sacral tuberosities from the midline (P<0.01, P<0.007). We suggest that palpation of the sacral tuberosities might indicate the location of the iliofemoral blood vessels.Abbreviations - TVT Tension-free vaginal tape - - MRI Magnetic resonance imagingEditorial Comment: The authors evaluated the distances and angles of the major pelvic blood vessels in the plane of the tension-free vaginal tape (TVT) procedure in 19 pelvic MR images. A statistically significant correlation was found between the distance of the iliofemoral vessels from the midline and the distance of the sacral tuberosities from the midline. The authors suggest that palpation of the sacral tuberosities might alert the surgeon to those patients at greater risk for iliofemoral vessel injury during the TVT procedure.The main concern with this study is that the pelvic MR images were obtained in the supine position whereas the TVT is performed in the lithotomy position, which may change the relations of pelvic blood vessels with reference to the urethra. Further studies are needed to evaluate the clinical significance of this interesting observation in reducing vascular injuries during the TVT procedure.     

Development of vesical calculi following tension-free vaginal tape procedure

We present a case of a bladder stone that had formed around the intravesical portion of tension-free vaginal tape (TVT) material following unnoticed bladder perforation during the procedure. Endoscopic lithotripsy of the bladder calculi was performed and the TVT sling material was removed by an endoscopic approach. High clinical suspicion of bladder complications is necessary when evaluating patients presenting with urinary symptoms after a TVT procedure.     

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.     

Spontaneous delivery following tension-free vaginal tape procedure

There has been no report in the international literature concerning vaginal delivery following tension-free vaginal tape (TVT) procedure. Most gynecologists recommend cesarean section after TVT procedure. We present the case of a 37-year-old (gravida 2, para 2) woman who had spontaneous delivery at 40 weeks’ gestation after TVT procedure performed 10 months prior because of stress urinary incontinence. Five months after spontaneous delivery, the patient was shown to be continent, with no urinary leakage occurring following stress maneuver. Urodynamic evaluation showed normal urethral pressure profile and sufficient maximum urethral closure pressure. Introital ultrasound demonstrated the correct position of the Prolene tape. In cases of pregnancy following TVT procedure, a general recommendation of delivery by cesarean section may be questioned, since the function and correct suburethral position of the Prolene tape can also remain intact following vaginal delivery.     

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.     

Transobturator tape (TOT): Two years follow-up

AIMS: The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress incontinence (SUI). METHODS: One hundred and thirty patients were prospectively evaluated with history, physical examination, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ), urogenital distress inventory (UDI), and analog global satisfaction scale (GSS), and urodynamic studies. RESULTS: One hundred and seventeen patients (90%) had history of SUI, and 78 (60%) had urge incontinence. Pads/day (PPD) used was 2.48 +/- 2.42, and the score of IIQ 16.13 +/- 7.86, UDI 10.95 +/- 3.4, and GSS 1.41 +/- 1.67. All patients underwent TOT using the ObTape. Hospital stay was 0.84 +/- 0.76 days and catheter duration was 1.42 +/- 2.08 days. At a follow-up of 16.85 +/- 4.68 months, 13 patients (10%) have recurrent SUI, 21 (16.15%) persistent urge incontinence, and 1 (1.92%) de novo urge incontinence. The mean PPD is 0.15 +/- 0.56, IIQ 1.47 +/- 5.14, UDI 3.28 +/- 3.09, and GSS 8.29 +/- 1.64. Two patients (1.52%) developed urethral obstruction, five (3.84%) had vaginal extrusion of the tape, and two (1.52%) had intra-operative bladder perforation. CONCLUSIONS: These results demonstrate the safety and efficacy of the TOT. The short hospitalization and catheterization, low incidence of de novo urge incontinence and obstructive voiding offers a distinct advantage over existing techniques. No significant difference in outcome between patients with VLPP < or =60 cm H2O, and patients with VLPP >60 cm H2O was observed.     

A safe and simple solution for intravesical tension-free vaginal tape erosion: removal by standard transurethral resection

OBJECTIVE

To report our experience with the successful removal of visible tension‐free vaginal tape (TVT) by standard transurethral electroresection, as intravesical tape erosion after TVT is a rare complication, and removal can be challenging, with few cases reported.

PATIENTS AND METHODS

Five patients presenting with TVT erosion into the bladder were treated at our institutions from December 2004 to July 2007; all had standard transurethral electroresection. Their records were reviewed retrospectively to retrieve data on presenting symptoms, diagnostic tests, surgical procedures and outcomes.

RESULTS

The median (range) interval between the TVT procedure and the onset of symptoms was 17 (1–32) months. The predominant symptoms were painful micturition, recurrent urinary tract infection (UTI), urgency and urge incontinence. There were no complications during surgery. The storage symptoms and UTI resolved completely after removing the eroded mesh in all but one patient. Cystoscopy at 1 month after surgery showed complete healing of the bladder mucosa.

CONCLUSION

Although TVT erosion into the bladder is rare, persistent symptoms, particularly recurrent UTIs, must raise some suspicion for this condition. Standard transurethral electroresection seems to be a safe, simple, minimally invasive and successful treatment option for TVT removal.