Surgical outcomes of tension-free vaginal tape (TVT)- abbrevo® and TVT-obturator® for the treatment of stress urinary incontinence: a retrospective study

Finite element analysis of vaginal tape at different positions for the treatment of arcus tendineus fascia pelvis damage-induced stress urinary incontinence

BACKGROUND

The purpose of this study was to use the finite element analysis method to simulate sling surgeries for arcus tendineus fascia pelvis damage-induced stress urinary incontinence: tension-free vaginal tape and tension-free vaginal tape - obturator, to evaluate their therapeutic effects at different positions of the urethra, and to judge the occurrence of complications through the sling-urethra interaction force which is difficult to obtain clinically.

METHODS

Pelvic geometric model was constructed based on the MRI of a woman without pelvic floor diseases. The constraints between arcus tendineus fascia pelvis and the lateral wall of the vagina were removed to simulate arcus tendineus fascia pelvis rupture. Gradient abdominal pressure was applied to the incontinence model, and tension-free vaginal tape and tension-free vaginal tape - obturator were placed at the proximal (30 %), mid-distal (60 %), and distal ends (80 %) of the urethra, respectively.

FINDINGS

All three types of slings were able to return the parameters of the urethra and bladder to normal levels. High urethral pressure was observed with proximal placement. Distal placement led to a "knot" effect and sudden pressure spikes as abdominal pressure increased. Mid-distal placement resulted in the lowest urethral pressure. The pressure between tension-free vaginal tape and the urethra was generally greater than that between tension-free vaginal tape - obturator.

INTERPRETATION

Placing slings at various positions within the urethra can all treat arcus tendineus fascia pelvis damage-induced stress urinary incontinence; the mid-distal tension-free vaginal tape - obturator should be considered the preferred treatment option.

Can pelvic floor muscle function before surgery determine the outcome of surgical treatment of stress urinary incontinence in women?

AIM

The study aimed to determine whether pelvic floor muscle (PFM) function before surgery may correlate with the success of surgical interventions for treating stress urinary incontinence (SUI). Our hypothesis was that addressing identified variables in preoperative rehabilitation could potentially improve surgical outcomes.

METHODS

This prospective observational study was conducted at a single center and enrolled women qualified to mid-urethral tape insertion for SUI between 2020 and 2022. Digital palpation and manometry (Peritron™ 9300 V) were used to evaluate PFM function. The following parameters were acquired: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), the area under the curve during a 10-second MVC, moreover the ability to perform correct PFM contraction, reflexive PFM contraction during cough and relaxation were assessed. All measurements were performed before the surgical treatment and during follow-up assessments at 1, 3, and 6 months postoperatively. The primary endpoint of the study was defined as objective cure, characterized by a negative cough stress test (CST), along with a subjective assessment based on the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7).

RESULTS

The study involved 57 eligible female participants, all of whom completed the 6-month follow-up. Objective cure was observed in 75.44% of cases, while subjective cure was reported in 33%. There was no association between PFM parameters and surgical outcomes.

CONCLUSION

The success of surgical treatment of SUI 6 months postsurgery is not related to preoperative pelvic floor muscle function.

The effect of electroacupuncture applied to women with stress urinary incontinence on urinary incontinence severity and symptoms: Systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Stress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted.

OBJECTIVE

The aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence.

METHODS

Literature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool.

RESULTS

The analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD: -2.37, 95% CI: -3.29 to 1.45, Z = 5.07, p < 0.001), urinary leakage (SMD: -0.79, 95% CI: -1.02 to -0.55, Z = 6.60, p = 0.001) and incontinence episode frequency (SMD: -2.24, 95% CI: -4.17 to -0.32, Z = 2.29, p < 0.02).

CONCLUSION

In women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

One and five-year efficacy of tension-free vaginal tape (TVT) abbrevo and TVT-obturator in the treatment of stress urinary incontinence: a retrospective study

BACKGROUND

Surgical interventions are more effective than nonsurgical approaches in providing a cure for stress urinary incontinence (SUI). In this study, we aimed to assess the benefits of tension-free vaginal tape (TVT) abbrevo by comparing its efficacy and complications to those of TVT obturator.

METHODS AND RESULTS

49 and 47 patients at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between January 2013 and December 2016 were included in the TVT-O and TVT-A groups, respectively. We evaluate the success rate and perioperative complications associated with TVT-O and TVT-A. A questionnaire that utilized the Patient Global Impression of Improvement (PGI-I) Scale was employed to assess the impact of surgery. Patients were followed up at 1 year, and 5 years after surgery. There were no statistically significant differences found in the efficacy of the TVT-A group and TVT-O group during both the one-year (p = 0.4) and five-year (p = 0.32) follow-up periods. In the period of one-year follow-up, 95.9% (n = 47) of patients in the TVT-O group and 95.8% (n = 45) of patients in the TVT-A group demonstrated improvement. During the period of five-year follow-up, 87.8% (n = 43) of patients in the TVT-O group and 93.6% (n = 44) of patients in the TVT-A group demonstrated improvement.

CONCLUSIONS

Based on our findings, TVT-A and TVT-O procedures exhibited similarly high success rates and low frequencies of complications.

Quality of life and anxiety 12 and 36 months after surgical SUI treatment in postmenopausal women

BACKGROUND

Stress urinary incontinence (SUI) is a common condition that affects a significant group of postmenopausal women, lowering quality of life, leading to embarrassment, social isolation, and decreased physical activity. SUI can be treated with medication, behavioral changes, pelvic floor muscle exercises, or surgical intervention. This study aimed to assess the changes in quality of life, acceptance of illness, and impact on physical activity, in patients after the transobturator tape (TOT) procedure following long-term assessment.

MATERIAL AND METHODS

Forty-five women aged 71.52 ± 4.12 years took part in our follow-up project at 12 and 36 months after surgical intervention. The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Acceptance of Illness Scale Questionnaire (AIS), and International Physical Activity Questionnaire (IPAQ) were used in the study.

RESULTS

At 36 months after surgery, SUI using TOT showed a significant improvement in health acceptance. Also, there was a number of patients who reported a high level of acceptance according to the AIS.

CONCLUSION

Elderly women with SUI, after treatment by TOT, showed a significant improvement in health acceptance 3 years after the procedure.

A Comparative Study on the Clinical Efficacy of Simple Transobturator Midurethal Sling and Posterior Pelvic Floor Reconstruction

Background and Objectives: The purpose of this study was to compare the complications, success rate and satisfaction of pelvic floor reconstruction after transobturator midurethral sling (TOT) and TOT combined with pelvic floor reconstruction in the treatment of female stress urinary incontinence. To explore the pathogenesis of stress urinary incontinence after pelvic floor stress injury and improve the surgical treatment strategy. Materials and Methods: From 15 August 2018 to 24 February 2022, patients diagnosed with stress urinary incontinence (SUI) and secondary prolapse of the anterior pelvis were selected to receive surgically. Participants were followed up and evaluated at 2 months, 6 months and 1 year after treatment. According to the patient's chief complaint, the patient can urinate automatically without incontinence. The number of urinary incontinence and urine leakage was significantly reduced compared with those before operation. Urinary incontinence symptoms did not improve or worsen as ineffective, observing the efficacy and complications. Results: We included 191 patients in the TOT group and 151 patients in the pelvic floor reconstruction group after TOT was combined. The operation time and hospital stay in the TOT group were short, but the TOT group needed a second operation to treat recurrent SUI. Perioperative complications were mostly dysuria, and the incidence of postoperative complications in the group of TOT combined with pelvic floor reconstruction was low. The complete success rate and effective rate of pelvic floor reconstruction after TOT in the merger group were significantly higher than those in the TOT group, and the patient satisfaction and complete success rate were also higher. Conclusions: TOT combined with posterior pelvic floor reconstruction has a definite short-term effect on patients with SUI and anterior pelvic secondary prolapse. The operation design should pay attention to the support of the posterior wall of the perineum to the bladder neck and the middle and proximal end of the urethra.

Micturition symptoms in gynecologic cancer patients receiving paclitaxel and platinum-based chemotherapy regimen: a prospective study

OBJECTIVE

To evaluate the effect of paclitaxel and platinum-based chemotherapy (PT) on micturition symptoms.

METHODS

All gynecologic cancer patients who were assigned to receive the PT regimen and understood the Thai language were invited to participate in this study. The exclusion criteria were as follows: abnormal urinary symptoms, retained urinary catheter or percutaneous nephrostomy, anticholinergic drug use, or scheduled to receive radiation therapy after the completion of chemotherapy. The participants were interviewed using three Thai validated questionnaires, the incontinence impact questionnaire-short form, urogenital distress inventory short form, and Sandvik score, on the day before receiving the first cycle of chemotherapy (pre-treatment), on the day before receiving the 4th cycle (mid-treatment), and 46 weeks after completing 69 cycles (post-treatment). The scores at the three time points were compared. Patients who received less than three cycles were not included in the analysis.

RESULTS

One hundred and ten patients were included in this study. There were significant differences in the median questionnaire scores at the three time points for both carboplatin plus paclitaxel and cisplatin plus paclitaxel. However, when using a pairwise difference between the two treatment protocols, there were no significant changes in the score from pre-treatment to post-treatment.

CONCLUSION

The PT regimen has an impact on micturition symptoms during chemotherapy which recover after treatment completion.

Medium Term Outcomes of TVT-Abbrevo for the Treatment of Stress Urinary Incontinence: Efficacy and Safety at 5-Year Follow-Up

Background and objectives: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting approximately 46% of adult women. After failure of conservative treatment, the mid-urethral sling (MUS) is considered the most effective and safe surgical procedure for SUI. In 2012, Waltregny et al. introduced a new trans-obturator tension-free vaginal tape (TVT) procedure, named TVT-abbrevo (TVT-A). The aim of the present study is to evaluate the efficacy and safety of the TVT-A procedure in women with pure SUI at 5-year follow-up. Materials and Methods: All women who complained of pure SUI symptoms with concomitant urodynamic stress incontinence (USI) were prospectively enrolled and treated with the TVT-A procedure. Postoperative subjective outcome measures included: International Consultation on Incontinence Questionnaire-Short Form (ICI-Q SF), Patient Global Impression of Improvement (PGI-I) scale, and patient degree of satisfaction scale. A PGI-I score ≤ 2 and a patient-satisfaction score ≥8 were used to define subjective success. Objective success was defined as the absence of urine leakage during a cough stress test. Adverse events were collected according to the Clavien-Dindo classification during follow-up. Results: Univariable analysis was used to investigate outcomes. Fifty women who met the inclusion criteria underwent TVT-A implantation. At 5 years after TVT-A implantation, 38 out of 45 (84.4%) patients were subjectively cured (p for trend 0.05), and 40 out of 45 (88.9%) patients were objectively cured (p for trend 0.04). A significant trend of de novo OAB symptoms was reported (22.2% [10/45]) at the 5-year follow-up. No serious early or late complications such as urethral/bladder injury, persistent groin-thigh pain, and sexual dysfunction that required mesh removal were detected. The univariate analysis did not reveal any risk factors (i.e., age, body mass index (BMI), menopause, obstetric factors, and preoperative ICIQ- SF questionnaire) statistically associated with failure of the TVT-A procedure. Conclusions: In conclusion, the 5-year follow-up results of this study demonstrated that TVT-A is a safe and effective option for treatment of SUI with a very low rate of post-operative groin-thigh pain.