Interdisciplinary combined sacrocolporectopexy: Results after one-year follow-up

Complications of Mid Urethral Slings: Important Outcomes for Future Clinical Trials

Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline

When I was a resident, my leader taught me that the gold standard forpatients with stress incontinence is the Marshall–Marchetti–Krantz(MMK) procedure. But a few years later, urologists who could performadvanced techniques showed me needle suspension as the best methodat a urological meeting. Fortunately my boss gave me a chance for ahand-to-hand lesson of the stamay procedure by the specialist. Sincethen, I have been selecting this procedure for a few years. Withoutdoubt, this needle suspension was the gold standard at that time.But now most urologists do not select this technique because of badresults. After I had mastered the technique of tension-free vaginal tape(TVT), I could see the smiling faces of patients after the operation. Atthat time I believed that TVT would be the gold standard for thiscondition. But the present status is what you know.Recently most specialists, including myself, believe that using‘mesh’ is the best operation for patients with pelvic organ prolapse. Isthis tendency good for the patients in the long run? No one can predictthe results of this procedure more than ten years from now.God knows what procedure will be the gold standard in the future.Assistant Professor Yasuyuki Suzuki

Objective To investigate the application value of MRI in evaluating the disorders of pelvic floor in female stress urinary incontinence (SUI). Methods From January 2017 to January 2019, the patients in the SUI group and the control group of Beijing Chaoyang Hospital, Capital Medical University were prospectively collected. Some patients in the SUI group were treated with tension-free vaginal tape (TVT). The dynamic MR was performed in both SUI patients and volunteers, and the following functional MR parameters were assessed between two groups: the urethral length and urethral hypermobility; the opening of urethral and bladder neck; and the pelvic organ prolapse. For SUI patients, the functional changes of the pelvic floor on MRI after TVT was also analyzed. Chi-square test, rank-sum test and t test were used. Results Comparing with the control groups (n=25), the urethral hypermobility, shortening functional urethral length, bladder neck funneling and urethra opening were significantly associated with SUI group (n=33). Thirty one patients were treated with TVT, 12 of them were reexamined with MRI at 3 to 6 months after operation. Postoperative MR showed that SUI patients had lower risk of the urethral opening and bladder neck funneling (P 0.05). Conclusion MRI can accurately evaluate pelvic floor function of SUI patients. However, TVT did not significantly improve weak pelvic supporting structures and pelvic organ prolapse. Key words: Urinary incontinence, stress; Magnetic resonance imaging; Tension-free vaginal tape; Pelvic floor disfunction; Pelvic floor

Outcomes Following Repeat Mid Urethral Synthetic Sling After Failure of the Initial Sling Procedure: Rediscovery of the Tension-Free Vaginal Tape Procedure

Predictors of Success With Postoperative Voiding Trials After a Mid Urethral Sling Procedure

Tension-free vaginal tape and associated procedures: a case control study.

Collagen Injection for Female Urinary Incontinence After Urethral or Periurethral Surgery

The Aim of the Study: To compare TVT (tension - free vaginal tape) and TVT - O (tension - free vaginal tape obturator) operations: results, complications, effectiveness after 5 years of follow - up. Material and M ethods: A single center nonblind, prospective study of women with SUI who were randomized to TVT and TVT - O from April 2005 to April 2013. Prospective study out of 394 patients, 114 were operated using TVT operation and 280 patients – TVT - O operation. There was no significant difference between groups concerning the age, BMI (body mass index), parity, menopausal status and prolapse (no patients had cystocele greater than stage II). Results: Mean operat ive time was significantly shorter in the TVT - O group (18±4.6 min) compared with the TVT group (27±7.1 min). There were no significant differences in the effectiveness of both procedures after 5 years. Hospital stay was statistically significantly shorter in TVT - O group (1.2±0.5 days) than in TVT group (4.0±0.6 days). Significantly less complication were in TVT - O group. Conclusion: TVT and TVT - O operations are equally effective for the surgical treatment of female stress urinary incontinence. TVT - O had a sh orter operation time and a lower complication rate.

To investigate the long-term objective and subjective outcomes of the transvaginal high uterosacral ligament suspension(HUS) in treatment of severe pelvic organ prolapse (POP) . From Jun. 2003 to Mar.2013, 136 patients with severe POP quantitation (POP-Q) stage III-IV underwent transvaginal hysterectomy and HUS operation in the First Affiliated Hospital, General Hospital of People's Liberation Army. And 125 patients (91.9%, 125/136) were followed up at a mean of 5.4 years (range of 4.2-9.2 years) . Anterior colporrhaphy (79.2%, 99/125), posterior colporrhaphy (64.0%, 80/125), the perineorrhaphy (96.0%, 120/125) and tension-free suburethral slings (37.6%, 47/125) were performed concurrently, in which 53 (65%, 53/81) patients with severe cystocele and 5 patients (15%, 5/34) with rectocele were augmented with mesh, respectively. Concurrent operation and complications were studied. The objective success of the operation was defined as the leading vaginal edge above hymen.Subjective results were obtained quality-of-life questionnaires, including pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). The mean interval of following up was (5.4 ± 1.2) years.Four patients presented mild anterior vaginal wall prolapse, and the recurrence rate were 3.2% (4/125), but no reoperation and pessary treatment were needed. Therefore, the subjective and objective satisfaction rate was 94.4% (118/125) and 96.8% (121/125). The mean scores of PFDI-20 and PFIQ-7 at 5 years after the operations were 8, 7, significantly lower than 62, 64 (P < 0.01). There were 3 cases of ureter obstruction. Tension-free vaginal tape was performed on 47 cases with stress urinary incontinence (SUI) as indicated. The symptom of 2 patients was not improved significantly after the operation, but one was improved after 6 months. The rate of denovo SUI was in 2(1.6%, 2/125) patients, but no further treatment was needed. The transvaginal HUS was then conformed to be a safe, minimal traumatic, highly successful and durable procedure for severe POP, so it is worthy of being popularized for clinical application.

Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings

The Urethral Motion Profile Before and After Suburethral Sling Placement

Inside Out Transobturator Vaginal Tape for the Treatment of Female Stress Urinary Incontinence: Interim Results of a Prospective Study After a 1-Year Minimum Followup

A prospective, single-centre study to assess the outcome of incontinence surgery in the first 120 consecutive patients who had tension-free vaginal tape (TVT) by a single surgeon. All patients were initially seen at 3 months postsurgery, with a cough provocation test, measurement of residual urine volume and a satisfaction survey. At a mean of 26 months (6-42 months) after surgery, a validated telephone interview was performed. The operation was performed in accordance with the original technique described by Ulmsten et al. [Int Urogynecol J Pelvic Floor Dysfunct 1996; 7: 81-5]. A total of 87 of 120 patients completed the study with the others either not complying or having died. Sixty-three (72.4%) patients were completely dry on cough provocation test. Of these, four (4.5%) had a slow stream and 10 (11.4%) suffered persistent urgency. The remaining 24 patients had varying degrees of leakage (operative failure). Sixteen (18.3%) patients subjectively considered the procedure to have failed at 3 months follow-up, either because leakage occurred once or more a day, and/or the persistence of the preoperative frequency/urgency syndrome. Of these 16 TVT failures, two had previous pelvic radiotherapy, two had double incontinence and eight had TVT for recurrent incontinence. Among the failures, 81.3% had mixed incontinence with predominant urge and nocturia three times per twenty four hours. Our study highlights the need for selection when performing TVT. We recommend that TVT be performed for those who have simple stress incontinence failing conservative measures (pelvic floor exercises and physiotherapy), with no history of incontinence surgery, pelvic radiotherapy, faecal or mixed incontinence.

Korea Purpose: Hysterectomy, regardless of the surgical technique, increases the risk of having to undergo stress urinary incontinence surgery later in life. Furthermore, transvaginal hysterectomy may cause some changes in the normal architecture and tension of the tissues surrounding the pelvic floor, and this may also cause some changes in the continence mechanisms of the bladder and urethra. We investigated if there are any adverse effects of concomitant vaginal hysterectomy on the outcomes of a tension-free vaginal tape procedure. Materials and Methods: The outcomes of the tension-free vaginal tape (TVT)/transvaginal total hysterectomy (VTH) group were compared with that of the TVT group in terms of cure and improvement of incontinence, satisfaction with the procedure and the complications. The preoperative evaluation included history taking, physical examination and stress tests and determining the stress-related leakage, the emptying ability, the anatomy, the protection and the inhibition (SEAPI) scores. The outcomes were evaluated at over one year after operation. Results: The cure and improvement rates were 77.5% and 15% in the TVT group, and 88.9% and 7.4% in the TVT/VTH group, respectively, without any statistical difference between the two groups. The rates of patientsatisfaction with the procedure were similar in two groups. There were no serious or long term complications related to the procedure except for a case of local hematoma in the hysterectomy site, which was controlled conservatively. Conclusions: Our findings suggest that a TVT operation can be done simultaneously with vaginal hysterectomy with similar results as those of TVT operation only. In addition, it is thought that the simultaneous TVT operation in a patient who is undergoing hysterectomy and has urinary stress incontinence deserves to be recommended in a positive light. (Korean J Urol 2008;49:850-854)