Groin pain after a tension-free vaginal tape or similar suburethral sling: management strategies

OBJECTIVE

To review different treatment strategies for women with groin pain after tension‐free vaginal tape (TVT) or similar suburethral sling procedures.

PATIENTS AND METHODS

The series comprised 450 women who had a TVT procedure, with a follow‐up of 3–50 months. Five women (1%) reported significant groin pain and were offered further treatment. In addition, one woman was referred from another centre and received treatment.

RESULTS

Women with pain were initially treated conservatively, and in most the pain resolved and required no further treatment. Persistent or severe discomfort was treated with a combined steroid (methyl prednisolone, 2 mL, 80 mg) and local anaesthetic (bupivacaine, 10 mL, 0.5%) injection in four women. There were no side‐effects from the treatment. One woman was relieved of her pain and required no further treatment. In one woman the local injections failed to improve her symptoms but the pain was not severe enough to warrant further treatment. Two women developed recurrent pain after an initially successful injection, and in these women the TVT was excised. One woman referred from another centre was primarily treated with TVT excision. In the three women treated with distal tape excision, the mean pain scores decreased from 8.7 before excision to 0.7 afterward. One woman is awaiting tape excision.

CONCLUSION

If conservative management fails to relieve the symptoms of groin pain it can be treated by injecting a mixture of steroid and local anaesthetic. However, local injection failed to provide long‐term relief in three of four women. More severe symptoms might require TVT mesh dissection and excision, which provided significant pain relief.

     

A new,simple, safe,effective and cost-effective procedure for genuine stress incontinence: midurethral polypropylene sling

We developed a cost-effective procedure for genuine stress incontinence (GSI) that has the advantages of the tension-free vaginal tape (TVT). The midurethral polypropylene sling procedure (MPS) is carried out under local anaesthesia. A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia using a needle and the sling is placed around the urethra. Ten patients underwent the MPS and were followed up for a mean of 6.2 months. All patients were cured. The short-term results of the MPS were comparable to those of the TVT. The procedure costs approximately US dollar 9. We conclude that the MPS can be considered as an alternative to the TVT procedure.     

Tension-free vaginal tape procedure is an ideal treatment for obese patients

OBJECTIVES: The purpose of this study was to evaluate the effect of obesity on the success of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. Specifically, do patients with a body mass index (BMI) of 35 kg/m(2) or greater have a lower cure rate of stress urinary incontinence?STUDY DESIGN: This retrospective cohort study identified 35 patient pairs who had undergone TVT in Winnipeg, Manitoba, Canada, for stress urinary incontinence from November 1999 to July 2001. Obese patients (defined as BMI greater than or equal to 35 kg/m(2)) were paired with nonobese patients (defined as BMI less than or equal to 30 kg/m(2)). The subjects were matched for age (within 5 years) and prior continence surgeries. Patients with a maximum urethral closure pressure of less than or equal to 20 cm H(2)O were excluded. Follow-up was either by objective cough stress test or subjective cure assessed by telephone interview. Cure was defined as no postoperative stress incontinence. Statistical analysis was performed by conditional logistic regression for matched controls. RESULTS: The follow-up range was 6 to 24 months. There were seven failures in all, four in obese and three in nonobese patients, giving cure rates of 88.6% and 91.4%, respectively. This difference was not statistically significant (P>.05). There were five bladder perforations (identified at the time of the procedure), all occurring in nonobese patients (P< .05). CONCLUSION: These data do not demonstrate a difference in cure of TVT in obese versus nonobese patients. Given the finding of fewer complications, this procedure may be an ideal surgical treatment modality for stress urinary incontinence in obese women.     

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.     

阴道无张力尿道中段悬吊带术后尿潴留发生及危险因素研究

目的:确定阴道无张力尿道中段悬吊带术(TVT)后尿潴留的发生率,探讨影响膀胱排空功能障碍的相关因素及其防治措施。方法:回顾性分析136例行TVT手术患者的病例资料,其中97例同时行子宫切除或阴道壁修补术等其他妇科手术,术后第2天测残余尿,记录患者临床资料。结果:17例术后发生尿潴留,恢复时间平均为5.2天,13例术后1周内恢复正常排尿功能,2周内全部恢复正常。单因素分析显示年龄、产次及最大尿流率(≤20 ml/s)两组间差异有显著性,多因素分析显示只有最大尿流率有统计学意义(OR=0.076,P=0.040)。结论:行TVT术后发生尿潴留的患者大多在1周之内膀胱排空功能恢复正常,术前最大尿流率值对预测术后尿潴留发生有价值。     

无张力疝修补术治疗老年腹股沟疝15例护理体会

目的:总结无张力疝修补术治疗老年腹股沟疝护理方法。方法:术前充分准备,术后密切观察,加强体位、疼痛、饮食及预防并发症的护理。结果:患者术后恢复快,未发生与护理相关的并发症。结论:充分的术前准备和完善的术后护理是提高老年无张力疝修补术成功的关键。     

非哺乳期乳晕部瘘管20例诊治体会

认为本病的发生与乳头凹陷和乳腺导管发育异常有关,治疗的关键在于切开全长瘘管,清除管壁及异常组织,切除乳头凹陷处及延伸入导管内皮肤。采用瘘管切开加中药换药,配合蝶形胶布创口牵拉治疗,具有痛苦小,愈合时间短,复发率低,组织损伤少,能保持乳房及乳头外形等优点。临床治疗20例,均获痊愈。