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Plassais C, Cour F, Vidart A, Bosset PO, Pettenati C, Kennel T, Neuzillet Y, Lebret T. Retropubic tape surgery for stress urinary incontinence: can women be cured without voiding dysfunction? World J Urol 2023; 41:2489-2494. [PMID: 37470812 DOI: 10.1007/s00345-023-04492-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE Retropubic tension free vaginal tape (RP-TVT) has become the gold standard for surgical management of female stress urinary incontinence but is associated with voiding dysfunction (VD). We developed for more than 10 years a reproductible and totally tension free tape procedure. Our goal is to determine efficiency of this technique compared to the incidence of VD. METHODS We retrospectively reviewed patients who underwent RP-TVT in our center between 2011 and 2019. Subjective cure, VD (determined as maximum urinary flow rate (Qmax) < 15 mL/s or post void residual (PVR) volume > 150 mL, or tape's section or resection requirement for underactive bladder (UB) with significant PVR) was assessed at 1 year. The main objective was the evaluation of subjective cure and VD at 1 year. RESULTS On the 319 patients reviewed, 93% of the patients were dry and 10.9% presented VD at one year. UB (OR = 5.01 [1.55-16.44], p = 0.008), preoperative Qmax < 15 mL/s (OR = 0.89 [0.84-0.95], p = 0.001) and previous incontinence surgery (OR = 4.20 [1.54-11.46], p = 0.005) were associated with VD. Acute urinary retention concerned 4.7% of the population and all were resolved after 6 weeks postoperatively. We reported 0.3% of de novo urgency and patients without VD showed a significant decrease of their voiding time at 1 year. CONCLUSION The placement of RP-TVT without intraoperative tightening seems to be a safe technique ensuring a high cure rate and low occurrences of bladder outlet obstruction.
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Affiliation(s)
- C Plassais
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France.
| | - F Cour
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - A Vidart
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - P O Bosset
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - C Pettenati
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - T Kennel
- Department of Research, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - Y Neuzillet
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - T Lebret
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
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Aniuliene R. TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study. Open Med (Wars) 2015; 10:311-317. [PMID: 28352711 PMCID: PMC5152983 DOI: 10.1515/med-2015-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/04/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). METHODS A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). RESULTS Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. CONCLUSION the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.
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Affiliation(s)
- Rosita Aniuliene
- Lithuanian University of Health Sciences, Mickeviciaus str.9, Kaunas, LT-44307, Lithuania, Tel. +37068778631
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Indications, Contraindications, and Complications of Mesh in the Surgical Treatment of Urinary Incontinence. Clin Obstet Gynecol 2013; 56:257-75. [DOI: 10.1097/grf.0b013e31828563d2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Nwabineli NJ, Mittal S, Russell M, Coleman S. Long-term results of urinary stress incontinence treated with mid-urethral tape as a standalone operation or in combination with pelvic floor reconstruction. J OBSTET GYNAECOL 2012; 32:773-7. [DOI: 10.3109/01443615.2012.716107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Outcome of midurethral tape continence surgery in patients with and without urodynamically confirmed stress incontinence. Eur J Obstet Gynecol Reprod Biol 2012; 165:357-60. [PMID: 22959144 DOI: 10.1016/j.ejogrb.2012.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/27/2012] [Accepted: 08/15/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the outcomes of midurethral tape continence surgery in patients with urodynamically confirmed stress incontinence (USI) and patients with symptoms of stress urinary incontinence but normal urodynamic studies (NUDS) and a positive 1-h pad test. STUDY DESIGN Analysis of data collected prospectively from 356 women who underwent tension-free vaginal tape (TVT) surgery from June 1998 to September 2009. There were 25 women with NUDS but a positive pad test. Outcome measures in these 25 women were compared with 65 women with urodynamically confirmed stress incontinence. These 65 women were chosen as suitable controls from the group of 331 potential controls. All the women underwent TVT surgery under local or spinal anaesthesia. RESULTS The outcome measures were: (1) absence of stress urinary incontinence symptoms, (2) new occurrence of lower urinary tract irritative symptoms (LUTS), (3) persistent voiding dysfunction (VD), and (4) recurrent urinary tract infections (UTIs). Following TVT, stress incontinence was absent in 100% and 97% of patients in the NUDS and USI groups respectively. The occurrence of LUTS was 4% and 4.6% in the NUDS and USI groups, while VD was found in 4% and 4.6% and recurrent UTIs in 8% and 6.1% of the groups respectively. CONCLUSION There were no significant differences in outcomes following TVT in patients with and without urodynamically confirmed stress urinary incontinence.
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Evaluation and Management of Urinary Retention and Voiding Dysfunction After Sling Surgery for Female Stress Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0150-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hwang IS, Yu JH, Chung JY, Noh CH, Sung LH. One-year outcomes of mid-urethral sling procedures for stress urinary incontinence according to body mass index. Korean J Urol 2012; 53:171-7. [PMID: 22468212 PMCID: PMC3312065 DOI: 10.4111/kju.2012.53.3.171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 10/12/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of our study was to investigate the safety and efficacy of the suprapubic arch (SPARC) sling operation and the transobturator tape (MONARC) sling operation according to body mass index (BMI). Materials and Methods Between January 1, 2004, and July 12, 2009, a retrospective clinical trial was performed with 284 patients treated by the SPARC sling procedure and 49 patients treated by the MONARC sling procedure. The women were classified into 3 groups by BMI according to the WHO Expert Consultation: normal weight (A, BMI 18.5 to 22.9 kg/m2), overweight (B, BMI 23 to 27.5 kg/m2), and obese (C, BMI>27.6 kg/m2). Patients' characteristics and clinical outcomes of the operation were analyzed according to BMI at 1 year after surgery via questionnaires and interviews with the patients about their voiding symptoms and medical records. Results There were 103 patients in group A, 186 in group B, and 34 in group C. The objective cure rates for groups A, B, and C after the SPARC procedure were 94.4%, 96.7%, and 96.8%, respectively (p=0.321), and the subjective cure rates were 94.4%, 96.1%, and 96.8%, respectively (p=0.222). The objective cure rates for groups A, B, and C after the MONARC procedure were 100.0%, 90.9%, and 66.7%, respectively (p=0.742), and the subjective cure rates were 92.3%, 93.9%, and 66.7%, respectively (p=0.779). The complication rates were similar among the three study groups. Conclusions Mid-urethral sling procedures for urinary incontinence result in similar objective and subjective cure rates and postoperative complications irrespective of BMI.
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Affiliation(s)
- In Sung Hwang
- Department of Urology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Bjelic-Radisic V, Greimel E, Trutnovsky G, Zeck W, Aigmueller T, Tamussino K. Patient-reported outcomes and urinary continence five years after the tension-free vaginal tape operation. Neurourol Urodyn 2011; 30:1512-7. [DOI: 10.1002/nau.21148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 04/04/2011] [Indexed: 11/09/2022]
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Ward K, Hilton P. Minimally invasive synthetic suburethral slings: emerging complications. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.7.4.223.27116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Elbiss HM, Thomson AJM, Moran PA. How useful are the BSUG database outcome criteria: validation using the MESA questionnaire. J OBSTET GYNAECOL 2011; 30:716-20. [PMID: 20925618 DOI: 10.3109/01443615.2010.506965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Urinary stress incontinence is common, but there is a wide range of prevalence which might account for variations in definition of incontinence and variations in study methodology. Our study assessed the validity and reliability of the British Society of Urogynaecology's (BSUG) database subjective outcome scores after the tension-free vaginal tape (TVT), by correlating these with the changes in the Medical Epidemiologic and Social Aspects of Ageing (MESA) questionnaire score. A total of 100 women with urodynamic stress incontinence underwent TVT, completed a MESA questionnaire preoperatively and at 6 months postoperatively. We also collected information about three outcome measures of the BSUG database, patients' global impression of outcome and stress and urge symptom analyses. Our study showed that the postoperative patients' global impression of outcome improved significantly in 85% of cases and had 73.89% reduction in mean MESA scores (p < 0.001). The outcome measures of the BSUG database relates well to symptom improvement, based on MESA scores and these subjective assessments currently used by the BSUG's database are a valid assessment of TVT outcome.
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Affiliation(s)
- H M Elbiss
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Dasgupta J, Goddard JC, Mayne CJ, Tincello DG. The Management of Voiding Dysfunction following Mid Urethral Tape Insertion. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.bjmsu.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: No standard regimen has been established for the management of postoperative voiding dysfunction following TVT insertion. This study was designed to compare two different strategies for management of this problem. Methods: This is a retrospective study of women operated on within a tertiary referral unit. Two cohorts were identified: those managed by clean intermittent self catheterization (CISC) during 2006, and those managed by ‘pull-down’ of tape in the immediate post-operative period during 2007. Specific measurements include number of patients with resumption of normal voiding and time taken for resolution of symptoms. Incidence of tape division, recurrence of stress incontinence and development of overactive bladder (OAB) were also measured. Results: The incidence of voiding difficulty following TVT insertion remained the same in 2006 and in 2007. 45.5% of the CISC group resumed normal voiding compared to 100% of the ‘pull-down’ group. The incidence of tape division and reappearance of stress incontinence was 54.5% and 27% respectively in the CISC group compared to none in the ‘pull-down’ group. The CISC group also had higher incidence of OAB. Conclusions: Immediate “pull-down” of tape is an effective way of managing voiding dysfunction following TVT with an excellent rate of symptom resolution without any need of further intervention.
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Affiliation(s)
| | | | | | - Douglas G. Tincello
- University of Leicester, Reproductive Science Section, Cancer Studies & Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK
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Kapoor R, Maheshwari R, Kapoor D, Singh UP, Upadhyay R. Is modified Raz technique of midurethral sling a reliable and cost-effective method of treating stress urinary incontinence? Indian J Urol 2011; 27:34-8. [PMID: 21716887 PMCID: PMC3114585 DOI: 10.4103/0970-1591.78418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We report our experience of pure stress urinary incontinence (SUI) treated by midurethral synthetic sling placement by modified Raz technique. MATERIALS AND METHODS Fifty-three patients with pure SUI operated at our institute between June 2003 and December 2008 were included in this study. Midurethral sling tape, fashioned from commercially available large pore synthetic mesh, was placed using the modified Raz technique. The technique consisted of placing the tape within retropubic space using double-pronged needle, which is passed under finger control through the fascia and retropubic space. Outcomes were assessed on the basis of patient's interview in follow-up OPD. RESULTS Mean age was 57.68 (28-69) years. Forty-five (85%) patients were totally dry and eight (15%) socially dry at the end of the follow-up. Mean operative time was 46.5 + 11.3 minutes (35-80 minutes). None of the patients required blood transfusion or had bladder/bowel injury. Mean duration of hospital stay was 2.17 days (2-4 days). Mean duration of follow-up was 46.1 months (12-78 months). CONCLUSIONS Modified Raz technique is safe and cost-effective for placing midurethral sling for genuine stress incontinence.
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Affiliation(s)
- Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Ruchir Maheshwari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Deepa Kapoor
- Department of Obstetrics and Gynaecology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Uday P. Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Rohit Upadhyay
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
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Rigaud J, Delavierre D, Sibert L, Labat JJ. [Management of chronic pelvic and perineal pain after suburethral tape placement for urinary incontinence]. Prog Urol 2010; 20:1166-74. [PMID: 21056399 DOI: 10.1016/j.purol.2010.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/16/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The surgical treatment of stress urinary incontinence is essentially based on TVT or TOT suburethral tape placement. The purpose of this article is to review the literature on the diagnostic and therapeutic approach to chronic pelvic and perineal pain following suburethral tape placement for urinary incontinence. MATERIAL AND METHODS A comprehensive review of the literature was performed by searching Pubmed for articles on pelvic and perineal pain following suburethral tape placement. RESULTS The role of suburethral tape in the pathogenesis of pain is essentially based on the fact that pain occurs immediately or over the days following tape placement. The clinical features are usually fairly nonspecific, with pelvic myofascial pain, possibly associated with direct or indirect nerve lesions (obturator nerve or pudendal nerve). Local infiltration of anaesthetic along the tape is performed for diagnostic purposes to confirm the aetiology of the pain and can also have a temporary therapeutic efficacy. Surgical removal of the tape was performed with satisfactory intermediate-term results in about two out of three cases. CONCLUSION The frequency of chronic pelvic and perineal pain following suburethral tape placement appears to be underestimated. The diagnostic approach is based on complete clinical examination and infiltration along the tape and any nerves involved. Surgical removal of the tape provides the best intermediate-term analgesic results.
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Affiliation(s)
- J Rigaud
- Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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[Sub-urethral sling in the treatment of female urinary incontinence: which? how?]. ACTA ACUST UNITED AC 2010; 38:607-19. [PMID: 20880735 DOI: 10.1016/j.gyobfe.2010.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 05/03/2010] [Indexed: 11/23/2022]
Abstract
Review of the literature that formed the basis for drafting the guideline on the sub-uretral sling in the first-line surgical treatment of female stress urinary incontinence. Medline database query since the introduction of TVT on the questions of various chapters and sub-chapters of the present article. The use of tapes made of polypropylene monofilament exclusively, knitted, is recommended to the exclusion of any other material. Regarding the choice of procedure, the objective cure rate of transobturator and retro-pubic routes cannot be evaluated clearly because of vague evaluation criteria from one study to another. Without adequate clinical trials proving their efficacy and safety, the mini-bands can so far be recommended to treat female stress urinary incontinence. Moderate overweight does not affect the results of laying tape. In patients with severe obesity, surgery to correct obesity is even better than surgery for incontinence. Age is not a contra-indication. If the patient is young and nulliparous, it is reasonable to advise her to postpone surgery after her last pregnancy. In case of multiparous patient, the risk of vaginal delivery does not seem sufficient to suggest a cesarean section. To conclude, sub-urethral slings are the first-line surgical treatment of female stress urinary incontinence.
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Functional Results After Tape Removal for Chronic Pelvic Pain Following Tension-Free Vaginal Tape or Transobturator Tape. J Urol 2010; 184:610-5. [DOI: 10.1016/j.juro.2010.03.132] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Indexed: 11/19/2022]
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Yoo DH, Noh JH. Readjustable sling procedure for the treatment of female stress urinary incontinence with intrinsic sphincter deficiency: preliminary report. Korean J Urol 2010; 51:420-5. [PMID: 20577610 PMCID: PMC2890060 DOI: 10.4111/kju.2010.51.6.420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 05/27/2010] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The Remeex (Mechanical External Regulation) sling is a mid-urethral sling that allows adjustment of the sling tension in the postoperative period. We evaluated the early outcomes of the procedure in patients in whom the success rate of tension-free slings is low, such as with intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS We included 17 women with urodynamically proven stress urinary incontinence (SUI) who underwent the Remeex procedure and were followed for at least 12 months. The patients were considered to have ISD on the basis of a Valsalva leak point pressure (VLPP) <60 cmH(2)O or a maximum urethral closure pressure (MUCP) <20 cmH(2)O. We analyzed parameters including history taking, urodynamic study (UDS), and postoperative clinical outcomes. Patient's success and satisfaction rates were evaluated after the procedure. Also, we asked about lower urinary tract symptoms (LUTSs) with a questionnaire, and the severity of LUTSs was assessed with the Visual Analog Scale (VAS) before and 12 months after the operation. RESULTS The patients' mean age was 55.6+/-9.58 years. Four (23.5%) patients had mixed incontinence. Five patients (29.4%) had undergone previous surgery for SUI. At a mean follow-up of 13.3 months (range, 12-16 months), 14 patients (82.3%) were cured and 3 patients (17.6%) were improved. Four patients (23.5%) answered very satisfied and 13 patients (76.4%) answered satisfied on the satisfaction questionnaire. Also, LUTSs were improved except voiding pain (p<0.05). CONCLUSIONS This procedure provides high cure and satisfaction rates. Our results demonstrate that the Remeex procedure is suitable for women with SUI with ISD.
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Affiliation(s)
- Dong Hoon Yoo
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
| | - Joon Hwa Noh
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
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Lee YS, Lee HN, Lee KS. The evolution of surgical treatment for female stress urinary incontinence: era of mid-urethral slings. Korean J Urol 2010; 51:223-32. [PMID: 20428423 PMCID: PMC2858859 DOI: 10.4111/kju.2010.51.4.223] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Accepted: 04/07/2010] [Indexed: 11/18/2022] Open
Abstract
Based on the integral theory, tension-free placement of a mid-urethral sling (MUS) for female stress urinary incontinence (SUI) has gained substantial popularity owing to the ease of the procedure and its effectiveness. Published series with long-term follow-up show continence rates after the MUS procedure ranging from 70% to 80%. Complication rates after MUS procedures are usually low. This review aimed to describe the historical change and the current use of the MUS. We discuss the efficacy and complications of various MUS procedures and the current strategies for managing failed slings.
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Affiliation(s)
- Young-Suk Lee
- Department of Urology, Masan Samsung Medical Center, Sungkyunkwan University School of Medicine, Masan, Korea
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Lim JL, de Cuyper EMJ, Cornish A, Frazer M. Short-term clinical and quality-of-life outcomes in women treated by the TVT-Secur procedure. Aust N Z J Obstet Gynaecol 2010; 50:168-72. [PMID: 20522075 DOI: 10.1111/j.1479-828x.2010.01139.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jeanette L Lim
- Department of Urogynaecology, Royal Women's Hospital, corner Grattan Street and Flemington Road, Parkville, Vic. 3052, Australia.
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Khandwala S, Jayachandran C, Sengstock D. Experience with TVT-SECUR sling for stress urinary incontinence: a 141-case analysis. Int Urogynecol J 2010; 21:767-72. [DOI: 10.1007/s00192-010-1114-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 01/20/2010] [Indexed: 11/29/2022]
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Hermieu JF, Debodinance P. Recommandations pour le traitement chirurgical de l’incontinence urinaire d’effort de la femme par bandelettes sous-urétrales. Prog Urol 2010; 20 Suppl 2:S112-31. [DOI: 10.1016/s1166-7087(10)70006-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Debodinance P, Hermieu JF, Lucot JP. Traitement chirurgical de première intention de l’incontinence urinaire d’effort de la femme. ACTA ACUST UNITED AC 2009; 38:S182-200. [DOI: 10.1016/s0368-2315(09)73578-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Costantini S, Nadalini C, Esposito F, Alessandri F, Valenzano MM, Mistrangelo E. Transobturator adjustable tape (TOA) in female stress urinary incontinence associated with low maximal urethral closure pressure. Arch Gynecol Obstet 2009; 282:277-84. [PMID: 19862541 DOI: 10.1007/s00404-009-1257-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 10/08/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Sergio Costantini
- Gynaecology and Obstetrics Department, University of Genoa, Genoa, Italy
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Allahdin S, McKinley C, Mahmood TA, Lyth D. Tension-free vaginal tape: 162 cases in a district general hospital. J OBSTET GYNAECOL 2009; 24:539-41. [PMID: 15369936 DOI: 10.1080/01443610410001722608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
From March 1999 to July 2002 a prospective study was carried out of 162 consecutive cases of urodynamically confirmed stress and mixed incontinence who underwent the tension-free vaginal tape (TVT) procedure. Patients were followed up at 6 weeks and 6 months and with a quality of life questionnaire at 1 year. The intraoperative complication rate was 7.6% and the postoperative complication rate was 18.8%. The subjective cure rate for patients suffering from urodynamic stress incontinence was 85%, with a further 11% experiencing significant improvement in their symptoms. The subjective cure rate for patients with mixed incontinence was 88%, with a further 9% experiencing significant improvement. The TVT procedure appears to be safe and effective for both stress and mixed incontinence for up to three years in a district general hospital. Complications in the short term are uncommon and can be managed easily.
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Affiliation(s)
- Sabeena Allahdin
- Department of Obstetrics and Gynaecology, Forth Park Hospital, Kirkcaldy, Scotland, UK.
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Duckett JRA, Patil A, Papanikolaou NS. Predicting early voiding dysfunction after tension-free vaginal tape. J OBSTET GYNAECOL 2009; 28:89-92. [DOI: 10.1080/01443610701811837] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Song PH, Hyun CH, Lim HS, Jung HC. Five-Year Outcomes of the IRIS Procedure for the Treatment of Female Stress Urinary Incontinence: Comparison with the TVT Procedure. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.8.767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Phil Hyun Song
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Chang Ho Hyun
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Hwa Su Lim
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Hee Chang Jung
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
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Ahmad I, Krishna NS, Small DR, Conn IG. Aetiology and Management of Acute Female Urinary Retention. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.bjmsu.2008.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aims: Interest in female urinary retention has increased recently because of improved understanding in the pathophysiology as well as the availability of specialised treatments such as sacral neuromodulation. There is little in the literature regarding the incidence and aetiology of urinary retention in females. We therefore undertook a review of all female retention patients presenting to our urology unit over an 11 year period. Methods: 300 females presented with retention in 11 years January 1996 to January 2007 (7% of the male incidence). 81 presented more than once. Median age was 67. Aetiology included urethral stenosis ( n = 51), urinary tract infection ( n = 33), constipation ( n = 23), neurological causes ( n = 14), gynaecological causes ( n = 16), non urological post-operative patients ( n = 21), medications ( n = 7) and clot retention secondary to bladder cancer ( n = 12). Results: Ultrasound ( n = 240) was carried out in the majority, cystoscopy ( n = 140), and urodynamics in a minority ( n = 38). Urethral pressure profilometry ( n = 38) revealed significantly higher closure pressures as compared to a control group—median 90 vs. 57mmH20 ( p = 0.02). 245 had successful trials without catheter. Prior to this, treatments included cystoscopy and urethral dilatation ( n = 73), laxatives ( n = 25) or antibiotics ( n = 29). Initially 54 patients were taught intermittent self-catheterisation; 38 patients were unable to perform this, and left with a long-term catheter. Conclusions: The number of female retentions encountered in our practice is fairly high, with very few of these fitting the criteria for sacral nerve stimulation. In a third no aetiology was found. Approximately half of those who successfully voided did so with no treatment.
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Affiliation(s)
- Imran Ahmad
- Beatson Institute for Cancer Research, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, Scotland, UK
| | | | - Douglas Ramsay Small
- Department of Urology, Southern General Hospital, 1345 Govan Road, Glasgow, Scotland, UK
| | - Ian Graeme Conn
- Department of Urology, Southern General Hospital, 1345 Govan Road, Glasgow, Scotland, UK
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27
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Sim WS, Lee KY, Kim KH, Jung H, Yoon SJ. Surgical Outcomes after Distal Suburethral Sling Procedures for Stress Urinary Incontinence in Aged Patients. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.10.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Won Seok Sim
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Kwang Yeom Lee
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Khae Hawn Kim
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Han Jung
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Sang Jin Yoon
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
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Midurethral minimally invasive sling procedures for stress urinary incontinence. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:728-733. [PMID: 18786297 DOI: 10.1016/s1701-2163(16)32923-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide an update on currently used minimally invasive surgical treatments for stress urinary incontinence in women: tension-free vaginal tape (TVT) procedure, transobturator tape (TOT) procedure, and other midurethral sling devices. OPTIONS The discussion is limited to minimally invasive surgical management of stress urinary incontinence in women. EVIDENCE A search of PubMed and Cochrane library for articles published in English before the end of February 2008 identified the most relevant literature. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. VALUES This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada. BENEFITS, HARMS, AND COSTS Counselling for the surgical management of urinary incontinence should consider all benefits, harms, and costs of the surgical options.
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Schulz JA, Chan MC, Farrell SA, Easton W, Epp A, Farrell SA, Girouard L, Gupta C, Harvey MA, Larochelle A, Lovatsis D, McMillan B, Robert M, Ross S, Schachter J, Schulz JA, Wilkie D. Interventions de fronde mi-urétrales à effraction minimale visant à contrer l’incontinence urinaire à l’effort. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008. [DOI: 10.1016/s1701-2163(16)32924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Outcome measures after TVT for mixed urinary incontinence. Int Urogynecol J 2008; 19:927-31. [DOI: 10.1007/s00192-007-0557-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 12/27/2007] [Indexed: 11/26/2022]
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Cho JK, Song HJ, Choi KW, Cho ST, Kim KK. The Effects of Simultaneous Vaginal Hysterectomy on the Outcomes of a Tension-free Vaginal Tape Procedure for Female Stress Urinary Incontinence. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.9.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jin Kuk Cho
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Ha Jung Song
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Kyung Woo Choi
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Sung Tae Cho
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Ki Kyung Kim
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
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The Impact of Tension-Free Vaginal Tape on Overactive Bladder Symptoms in Women With Stress Urinary Incontinence: Significance of Detrusor Overactivity. J Urol 2008; 179:214-9. [DOI: 10.1016/j.juro.2007.08.151] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Indexed: 11/19/2022]
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Ballert KN, Kanofsky JA, Nitti VW. Effect of tension-free vaginal tape and TVT-obturator on lower urinary tract symptoms other than stress urinary incontinence. Int Urogynecol J 2007; 19:335-40. [PMID: 17874026 DOI: 10.1007/s00192-007-0450-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 08/17/2007] [Indexed: 10/22/2022]
Abstract
Variable effects on lower urinary tract symptoms (LUTS) other than stress urinary incontinence (SUI) have been reported after tension-free vaginal tape (TVT). We measured the effect of TVT on LUTS using the American Urological Association Symptom Index (AUASI). Patients undergoing TVT completed the AUASI pre- and post-operatively. Total scores (TS), storage scores (SS), and voiding scores (VS) were compared overall and among patients with SUI vs mixed urinary incontinence (MUI) and those who underwent TVT vs TVT-obturator (TVT-O). The mean change in TS and SS was -3.6 and -3.0. Mean reductions in TS and SS were significant in all patient subsets with no change in VS. There was no significant difference in the mean changes in TS between patients with SUI vs MUI or those undergoing TVT vs TVT-O. LUTS are improved after TVT in most patients. In general, voiding symptoms were not adversely affected.
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Affiliation(s)
- Katie N Ballert
- New York University, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA
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Andonian S, St-Denis B, Lemieux MC, Corcos J. Prospective Clinical Trial Comparing Obtape® and DUPS to TVT: One-Year Safety and Efficacy Results. Eur Urol 2007; 52:245-51. [PMID: 17234331 DOI: 10.1016/j.eururo.2006.12.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Accepted: 12/30/2006] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Obtape and DUPS are modifications of the original TVT procedure. To test these new products in terms of safety and efficacy, we designed a prospective clinical trial with a follow-up of at least 1 yr. METHODS We randomized 190 consecutive females with SUI for this study. They were evaluated by history, ICIQ-SF, physical examination, cystoscopy, UDS, and the 1-h pad test. Patients were reevaluated at 1, 6, and 12 mo. The ICIQ-SF and pad test were repeated at 1-yr follow-up. RESULTS There were 78, 32, and 80 patients in the Obtape, DUPS, TVT arms, respectively. An interim analysis after 32 patients in each arm indicated postoperative retention rates of 3 (9.4%), 6 (18.8%), and 4 (12.5%) patients in Obtape, DUPS, and TVT groups, respectively. Because of higher retention rate and suprapubic discomfort, DUPS was discontinued. At the end of the study, complete retention rates were 6 (7.8%), 6 (18.8%), and 6 (7.5%) in Obtape, DUPS, and TVT, respectively. TVT was the only procedure with bladder perforations at a rate of 14%. However, Obtape and DUPS were associated with more postoperative complications including complete retention, urethrolysis, hematoma, mesh erosion, UTI, and wound infection (13%, 28%, and 8%; p< or =0.025). At 1 yr, 83%, 94%, and 86% of patients in the Obtape, DUPS, and TVT groups were objectively cured (p>0.05). CONCLUSIONS TVT was the only procedure associated with bladder perforation, but there were more postoperative complications with Obtape and DUPS. No statistically significant differences in cure rates were observed at 1-yr follow-up. Longer follow-up is needed to confirm these results.
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Affiliation(s)
- Sero Andonian
- Department of Urology, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Descazeaud A, Salet-Lizée D, Villet R, Ayoub N, Abitayeh G, Cotelle O, Gadonneix P. Traitement de l'incontinence urinaire d'effort par bandelette TVT-O: résultats immédiats et à un an. ACTA ACUST UNITED AC 2007; 35:523-9. [PMID: 17512236 DOI: 10.1016/j.gyobfe.2007.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 03/19/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare one-year results between the classic retropupubic (TVT) and the in-out transobturator approaches (TVT-O) of tension-free vaginal tape for the treatment of stress urinary incontinence (SUI). PATIENTS AND METHODS The first 82 patients operated for SUI by TVT-O in our institution were included in the analysis. Patients were evaluated at 1 and 12 months. The global satisfaction rate was assessed at 12 months by a self-reported questionnaire. Results were compared to those of the first 124 patients operated of SUI by TVT in the same institution and by the same surgeons between 1996 and 1999. RESULTS Except a younger mean age in the TVT-O group (57 versus 60 years), no other preoperative parameter was significantly different between the TVT and the TVT-O groups. The mean operating time was shorter in the TVT-O group (15 versus 30 minutes, P<0.001). No intraoperative complication occurred. The rate of bladder perforation was significantly lower in the TVT-O group (0 versus 8.8%, P=0.004). The rate of post-voiding residual less than 100 ml was higher in the TVT-O group (88 versus 61%, P<0.001). In the TVT-O group, 40% of patients had postoperative inguinal pain (mean=9 days, range 2-15 days). After 12 months from TVT-O, 85% of patients were completely dry, 6% had de novo over bladder activity, and 93.5% of patients were satisfied with the treatment they received. The 12-month results were not significantly different between the TVT and the TVT-O groups. DISCUSSION AND CONCLUSION With a follow-up of 12 months, TVT-O is as efficient as TVT and has a lower risk of bladder injury, a cut by half operating time, and less postoperative dysuria.
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Affiliation(s)
- A Descazeaud
- Service deChirurgie Viscérale et Gynécologique, Groupe Hospitalier Diaconesses Croix-Saint-Simon, Paris, France
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Giberti C, Gallo F, Cortese P, Schenone M. Transobturator tape for treatment of female stress urinary incontinence: objective and subjective results after a mean follow-up of two years. Urology 2007; 69:703-7. [PMID: 17445655 DOI: 10.1016/j.urology.2007.01.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 10/08/2006] [Accepted: 01/05/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To verify the objective and subjective outcomes of transobturator tape (TOT) in the treatment of female stress urinary incontinence due to urethral hypermobility. METHODS A total of 108 consecutive patients with stress urinary incontinence (mean age 58 +/- 4.5 years), who underwent the TOT procedure (43 patients received the ObTape, 55 patients the Monarc, and 10 patients the I-STOP sling) from June 2002 to December 2004, were assessed in December 2005. Before surgery, the patients were evaluated by history, physical examination, stress test, cotton swab test (Q-Tip test), and ultrasonography. After surgery, the compilation of a specific quality-of-life questionnaire was also included. Of the 108 patients, 35 had previously undergone urogynecologic surgery; associated prolapse was repaired simultaneously in 45 patients. The outcomes were analyzed considering five postoperative aspects: obstructive symptoms, irritative symptoms, urinary continence, pain, and satisfaction. RESULTS Postoperatively, 74% reported minimal obstructive symptoms, 78.7% had no urge symptoms, and de novo urgency occurred in 14.8%. Objective continence rates were increased significantly (80%), although the subjective rate was significantly greater (92%). Also, 88% of patients reported no pelvic pain, and only 7.3% reported dyspareunia; 88% of patients were significantly satisfied with the TOT procedure. Regarding complications, vaginal erosions were reported, using the ObTape, in 6.4% of patients, sling rejection in 3.8%, and incorrect positioning or sliding of the sling in 6.4%. Morbidity did not seem to be affected by previous or associated surgery. CONCLUSIONS The TOT procedure is a simple, safe, and effective technique for the treatment of stress urinary incontinence due to urethral hypermobility. Our data have demonstrated good global success with a low rate of minor complications.
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Affiliation(s)
- Claudio Giberti
- Department of Nephrourology, Institute of Urology, San Paolo Hospital, Savona, Italy
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Anger JT, Litwin MS, Wang Q, Pashos CL, Rodríguez LV. Complications of sling surgery among female Medicare beneficiaries. Obstet Gynecol 2007; 109:707-14. [PMID: 17329524 DOI: 10.1097/01.aog.0000255975.24668.f2] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze Medicare claims data to determine short-term complications after sling surgery among female beneficiaries aged 65 years and over. METHODS We analyzed the 1999-2001 Medicare Public Use Files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. Women undergoing sling procedures between January 1, 1999, and July 31, 2000, (the index period) were identified by Physicians Current Procedural Terminology Coding System (4th edition) and tracked for 12 months. Main outcome measures were complications as identified by International Classification of Diseases (9th revision) (ICD-9) diagnosis codes and Current Procedural Terminology procedure codes in the first postoperative year. RESULTS A total of 1,356 sling procedures were performed during the index period. In the 3 months after the procedure, 12.5% of women developed surgical or urologic complications, and 33.6% were diagnosed with urinary tract infections. Within 1 year of the procedure, 6.9% of subjects had a new diagnosis of outlet obstruction, and 8.0% underwent treatments to manage outlet obstruction. There was a high incidence of new diagnoses of urge incontinence (15.2%) and treatment of pelvic prolapse (23.2%). Both cystoscopy and urodynamic testing, which may serve as indicators of possible complications, were performed frequently during the first year after surgery (32.4% and 30.5%, respectively). Patient race, age, and comorbidity each had a significant influence on outcomes. CONCLUSION Complication rates within 1 year after sling surgery among Medicare beneficiaries were found to be higher than those reported in the clinical literature. The high rates of postoperative urinary tract infections, prolapse, and outlet obstruction suggest the need for quality improvement measures in the management of women with incontinence and pelvic prolapse. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jennifer T Anger
- Department of Urology, David Geffen School of Medicine and School of Public Health, University of California, Los Angeles, California 90095, USA.
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Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, Nilsson CG. Retropubic Compared With Transobturator Tape Placement in Treatment of Urinary Incontinence. Obstet Gynecol 2007; 109:4-11. [PMID: 17197581 DOI: 10.1097/01.aog.0000249607.82768.a1] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the intraoperative and immediate postoperative performance of the retropubic tension-free vaginal tape (TVT) procedure with that of the transobturator tension-free vaginal tape (TVT-O) procedure as primary treatment for female urinary stress incontinence. METHODS Randomized multicenter comparative trial including four university hospitals and three central hospitals in Finland. Assessment preoperatively and 2 months postoperatively included a cough stress test and the following condition-specific quality of life questionnaires: the Urinary Incontinence Severity Score (UISS), the Detrusor Instability Score, the Incontinence Impact Questionnaire-Short Form, the Urogenital Distress Inventory-Short Form, and a visual analog scale (VAS). Operation time, theater time, hospital stay, intraoperative and immediate postoperative complications were recorded. RESULTS Of the 273 originally randomized patients, 267 underwent the allocated operation, 136 in the TVT group and 131 in the TVT-O group. No significant differences in objective or subjective cure rates were detected. Patients in the TVT-O group had a significantly longer hospital stay, needed significantly more postoperative opiate analgesia and had significantly more complications than the patients in the TVT group. Patients in both groups had a significant postoperative improvement in quality of life, as indicated by the results of all the questionnaires used, with no difference between the groups. CONCLUSION The TVT and the TVT-O procedures perform equally in terms of objective and subjective cure. The statistically significant higher complication rate in the TVT-O group is not regarded as clinically significant. CLINICAL TRIAL REGISTRATION (www.ClinicalTrials.gov), NCT00379314 LEVEL OF EVIDENCE I.
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Affiliation(s)
- Eija Laurikainen
- Department of Obstetrics and Gynecology, Turku University Central Hospital, Helsinki, Finland
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39
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Ko KT, Lee SH, Kim HY. The Factors Affecting the Success and Quality of Life after a Tension-free Vaginal Tape Procedure in Patients with Stress Urinary Incontinence. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.10.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kyung Tae Ko
- Department of Urology, School of Medicine, Hallym University, Seoul, Korea
| | - Seong Ho Lee
- Department of Urology, School of Medicine, Hallym University, Seoul, Korea
| | - Ha Young Kim
- Department of Urology, School of Medicine, Hallym University, Seoul, Korea
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40
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Lee GB, Kim HS, Koh JS, Kim HW, Lee YS, Suh HJ, Lee DH, Lee JY. The Changes of Storage Symptoms after Tension-free Vaginal Tape Procedures in Stress Urinary Incontinence Patients. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.12.1289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Gwang Bae Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Hyo Sin Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jun Sung Koh
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Hyun Woo Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Yong Seok Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Hong Jin Suh
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Dong Hwan Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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41
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Lee KG, Lee SI, Kim DJ. Clinical Outcome of the Tension-free Vaginal Tape Procedure for Treating Women with Urinary Incontinence (the 2-year Follow Up): Comparison between Stress Urinary Incontinence and Mixed Urinary Incontinence. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.7.712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kyung Gu Lee
- Department of Urology, Kwandong University College of Medicine, Goyang, Korea
| | - Sang Ik Lee
- Department of Urology, Kwandong University College of Medicine, Goyang, Korea
| | - Dong Jun Kim
- Department of Urology, Kwandong University College of Medicine, Goyang, Korea
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Konstantinos H, Eleni K, Dimitrios H. Dilemmas in the management of female stress incontinence: the role of pelvic floor muscle training. Int Urol Nephrol 2006; 38:513-25. [PMID: 17136582 DOI: 10.1007/s11255-006-0085-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 03/27/2006] [Indexed: 11/27/2022]
Abstract
Treatment options for female stress urinary incontinence include pelvic floor muscle training, lifestyle interventions, bladder retraining, pharmacotherapy, anti-incontinence devices and surgery. Several consensus statements recommend pelvic floor muscle training as first line treatment. The aim of this review is to analyse all the currently available data and propose a treatment algorithm for clinical practice. A literature-based critical presentation of all treatment modalities, methods of assessing efficacy and comparison between them using a patient-centered approach was made. Many of the studies are observational, non-randomized with several methodological problems that lead to confusion. Emphasis was made to high quality randomized trials. The proposed treatment algorithm established only on evidence-based data. Management strategy however, must identify patient expectations and involve them in the decision-making more than traditional measures of treatment success.
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Affiliation(s)
- Hatzimouratidis Konstantinos
- 2nd Department of Urology, Aristotle University of Thessaloniki, Kimiseos Theotokou 26B, 57010, Pefka Thessaloniki, Greece.
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43
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Primus G. One year follow-up on the SPARC sling system for the treatment of female urodynamic stress incontinence. Int J Urol 2006; 13:1410-4. [PMID: 17083393 DOI: 10.1111/j.1442-2042.2006.01586.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the safety and efficacy of the SPARC sling in women with urinary incontinence. METHODS Women who presented with urinary incontinence symptoms were included in this prospective study. In total, 103 women underwent evaluation of subjective and objective cure rates, quality of life and urodynamic parameters following the SPARC procedure. RESULTS The objective cure rate, defined as a pad weight test less than 1 g and negative cough stress test, was 84.4% at 12 months. Subjective cure rates, defined as no usage of pads/no urine loss during daily activities, were also encouraging: 75.0% at 12 months. Quality of life evaluation included asking patients to rate the amount of bother caused by their incontinence symptoms on a scale from 0 to 100. Preoperatively, the average was 76.7, dropping to 15.9 at 12 months. At 6 months, 93.7% (75/79) were 'very satisfied' and 5.1% (4/79) were 'satisfied;' one patient was 'dissatisfied' (1.2%, 1/79). Seventy-eight of 79 patients (98.7%) would recommend the procedure to a friend and undergo the procedure again. Patients returned to inside work an average of 1.4 days and to outside work 5.4 days after the procedure. The maximum flow rate decreased from a mean of 43.4 mL/s preoperatively to 37.08 mL/s at 12 months postoperatively (P = 0.049). Detrusor pressure at maximum flow and maximal urethral closure at rest increased from 16.94 and 50.85 cmH(2)O preoperatively to 21.69 and 60.61 cmH(2)O at 12 months, respectively (P = 0.015; P < 0.001). There were few postoperative complications, with no reported infections, erosions or hematomas. CONCLUSIONS This prospective study demonstrates that the SPARC suprapubic sling is a safe and effective treatment for female stress urinary incontinence. Both objective and subjective measures of success were achieved, with low complication rates. Quality of life and urodynamic parameters were improved. The SPARC method provides safe and highly effective treatment for female stress urinary incontinence at one year.
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Abstract
OBJECTIVES To objectively assess the success rate at 6 months after tension-free vaginal tape obturator (TVT-O) procedure. To assess subjective success rates, complications, patient satisfaction, and quality of life (QOL). DESIGN A prospective observational study. SETTING A tertiary referral urogynaecology practice. POPULATION A cohort of 100 consecutive women who underwent the TVT-O procedure between March and October 2004. METHODS The TVT-O technique was performed as described. Three standardised QOL questionnaires were completed preoperatively at 6 months and 12 months. At 6 months, a urogenital history, visual analogue scale score (VAS) for patient satisfaction, uroflow, and urinary stress test were performed. After 12 months, a urogenital history and patient satisfaction verbal analogue score (VeAS) were obtained by telephone interview. MAIN OUTCOME MEASURE Objective success rate of the TVT-O procedure was measured by negative stress test. Secondary outcomes were subjective success rates at 6 and 12 months, pre- and postoperative comparison of urodynamic parameters, complications, postoperative symptomatology, QOL analysis, and patient satisfaction. RESULTS Mean follow up was 18.5 months. Objective success rate was 95%. Subjective success rates were 92 and 84% at 6 and 12 months. Complications included recurrent urinary tract infection (six), voiding difficulty (two), persistent groin discomfort (three), haematoma (one), wound infection (one), vaginal tape erosion (one), and urethral irritation (one). Prevalence of de novo urge incontinence was 4.1 and 4.8% at 6 and 12 months. QOL analysis showed significant improvements in QOL scores postoperatively. Visual and verbal analogue scores indicated high patient satisfaction (VAS, VeAS >or= 80%) in 77 and 67% at 6 and 12 months. CONCLUSION The TVT-O is a safe and effective treatment for female stress urinary incontinence.
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Affiliation(s)
- J l Lim
- Department of Urogynaecology, Royal Women's Hospital, 132 Grattan Street, Carlton, Australia
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Liapis A, Bakas P, Giner M, Creatsas G. Tension-Free Vaginal Tape versus Tension-Free Vaginal Tape Obturator in Women with Stress Urinary Incontinence. Gynecol Obstet Invest 2006; 62:160-4. [PMID: 16707901 DOI: 10.1159/000093320] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND To assess the efficacy and complications of tension-free vaginal tape (TVT) versus tension-free vaginal tape obturator in women with urodynamic stress incontinence. METHODS Prospective, randomized study. Initially, 91 patients were included in the study and 89 of them were available at 12 months follow-up. Forty-six patients were subjected to classic TVT procedure and 43 to transobturator vaginal tape from inside to outside (TVT-O) operation. There was no significant difference between the groups for age, BMI, menopausal status and prolapse. No patients had cystocele greater than stage I. Subjective and objective cure and improvement rate, mean operative time, hospital stay and complications incidence were assessed. RESULTS Mean operative time was significant shorter in the TVT-O group (17.4 +/- 6.9 min) compared to the TVT group (26.7 +/- 8.6 min). There was no significant difference in the duration of hospital stay between two groups. The objective cure rate for TVT group was 89%, the improvement rate was 6.5%, the failure rate was 4.3% and the subjective cure rate 73.9%. The objective cure rate for TVT-O group was 90%, the improvement rate was 7.6%, the failure rate was 2.5% and the subjective cure rate 76.7%. The hemoglobin loss ranged between 1.0 +/- 0.5 g/dl for TVT group and 0.9 +/- 0.4 g/dl for TVT-O group. CONCLUSION The TVT-O technique presents success rates comparable to the classic TVT method in the short term.
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Affiliation(s)
- Angelos Liapis
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Athens, Greece
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Chêne G, Amblard J, Tardieu AS, Escalona JR, Viallon A, Fatton B, Jacquetin B. Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. Eur J Obstet Gynecol Reprod Biol 2006; 134:87-94. [PMID: 16891051 DOI: 10.1016/j.ejogrb.2006.06.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 05/11/2006] [Accepted: 06/13/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference studies. MATERIALS AND METHODS About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H(2)O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased). RESULTS About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment. DISCUSSION Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, "dysuria" in the broad sense did not affect the patients' quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques. CONCLUSION Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension.
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Affiliation(s)
- G Chêne
- Urogynaecology Unit, Maternity Hôtel-Dieu, Clermont-Ferrand University Hospital, 11 Boulevard Léon Malfreyt, 63058 Clermont-Ferrand Cedex 1, France.
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Mellier G, Mistrangelo E, Gery L, Philippe C, Patrice M. Tension-free obturator tape (Monarc Subfascial Hammock) in patients with or without associated procedures. Int Urogynecol J 2006; 18:165-72. [PMID: 16773232 DOI: 10.1007/s00192-006-0126-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 03/21/2006] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to evaluate the safety and efficacy of the tension-free obturator tape (TOT) procedure in patients having concomitant hysterectomy and/or pelvic reconstructive surgery. A chart review from August 2002 to December 2004 identified 341 consecutive female patients with stress urinary incontinence who had undergone a TOT procedure alone (Monarc only group) or a TOT procedure associated with hysterectomy or other pelvic reconstructive surgery (Monarc + other surgery group). Intraoperatively, three cases of hemorrhage occurred. No transfusions were required. There were no cases of bladder injury or injury to obturator nerves or vessels during needle passage via the transobturator route. Three cases of vaginal erosion were found at 3 months follow-up, but no tape removal was required. Two hundred fifty-four patients (74.5%) were contacted by telephone for a second follow-up (average 17 months, range 6-32) and the validated short forms of the Urogenital Distress Inventory (UDI-6) questionnaire and of the Incontinence Impact Questionnaire (IIQ-7) were administered. Results showed a very good quality of life score (0-7) in 93.3% patients. Globally, only three (1.2%) patients had persistent urine leakage related to physical activity. Severe voiding dysfunction occurred in five (2%) patients. The cure rate, considered as the complete absence of urine leakage (score 0 in questions 2 and 3 of the UDI-6), was 73.7% in the Monarc only group vs 57.4% in the Monarc + other surgery group. Pelvic floor defects, benign uterine disorders, and stress urinary incontinence can be safely treated with transobturator tape, using the Monarc device, and concomitant vaginal procedures.
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Affiliation(s)
- Georges Mellier
- Department of Gynecology and Obstetrics, Edouard Herriot Hospital, Lyon, France.
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Vervest HAM, Bisseling TM, Heintz APM, Schraffordt Koops SE. The prevalence of voiding difficulty after TVT, its impact on quality of life, and related risk factors. Int Urogynecol J 2006; 18:173-82. [PMID: 16633883 DOI: 10.1007/s00192-006-0127-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 03/22/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the prevalence of voiding difficulty (VD), quality of life, and related risk factors after tension-free vaginal tape (TVT). DESIGN Prospective cohort study in 703 women with a TVT procedure for stress urinary incontinence. MAIN OUTCOME MEASURES VD stated by women, Urogenital Distress Inventory (UDI-6) question 5 (difficulty in emptying the bladder), maximum flow rate, postvoid residual urine, necessity of postoperative catheterization, tape division, and impact on quality of life (Incontinence Impact Questionnaire, IIQ-7). RESULTS Postoperative catheterization (>24 h) was necessary in 11% and tape division in 1.3% of patients. There were 26% of women who stated VD and 25% reported moderate to great impairment on the UDI-6 after 36 months. While the negative impact on the outcome of TVT in women with abnormal voiding compared to women without is higher, the impact decreased significantly after TVT, implying a considerable improvement in quality of life. Pre-operative existing voiding difficulty and concomitant prolapse surgery were independent risk factors. CONCLUSIONS Symptoms of VD occurred after TVT and caused lesser improvement in quality of life.
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Affiliation(s)
- Harry A M Vervest
- Department of Gynecology and Obstetrics, St. Elisabeth Hospital, P.O. Box 90151, 5000 Tilburg, LC, The Netherlands.
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Lim JL, Quinlan DJ. Safety of a New Transobturator Suburethral Synthetic Sling (TVT-O) Procedure During the Training Phase. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:214-217. [PMID: 16650360 DOI: 10.1016/s1701-2163(16)32111-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The TVT-O (Ethicon, Somerville, NJ) is a new transobturator suburethral synthetic sling used in the treatment of female stress urinary incontinence (SUI). This study aimed to evaluate the complication rates and procedural times associated with performing this procedure during a period of transition from the retropubic tension-free vaginal tape (TVT) procedure to the transobturator TVT-O procedure. METHODS We performed a retrospective analysis of the first 50 patients to undergo the TVT-O procedure in one gynaecologist's practice. All patients had SUI or mixed urinary incontinence. Operative times and intraoperative and perioperative complications were recorded. At the two-week and six- to eight-week postoperative reviews, a urogenital history and examination were performed. RESULTS The only complications encountered were two cases (4%) of urinary tract infection and one case (2%) of superficial wound infection. There were no cases of postoperative voiding difficulty, hemorrhage, hematoma, persistent groin pain, or vascular or visceral injuries. The mean procedural time was 21 minutes. CONCLUSION These preliminary results indicate that the TVT-O procedure is a safe treatment for female SUI even during the training phase. In light of the safety and the ease of transition to this technique, this finding is encouraging for surgeons who are making the transition from other surgical procedures for female SUI to the transobturator TVT-O.
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Kim NS, Bae JH, Lee JG. Long-term Follow-up of the Tension-free Vaginal Tape (TVT) Procedure for Treating Female Stress Urinary Incontinence. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.7.729] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- No Soo Kim
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Jae Hyun Bae
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
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