Abstract
AimTo examine the position of the TVT-O sling 10 years postoperatively and its association with outcome.MethodsA total of 124 patients who received a TVT-O sling at two centers in 2004 and 2007 were invited for follow-up. The position of the sling on perineal ultrasound was described relative to the bladder neck and the lower margin of the pubic symphysis at rest and on Valsalva. Objective cure was defined as a negative cough stress test at 300 ml. Subjective cure was evaluated with the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire (IOQ), Female Sexual Function Index Questionnaire (FSFI) and the Patient Global Impression of Improvement score (PGII).Results78 of 124 patients (57%) were available for follow-up 10 years after surgery. I Eleven (14%) had undergone reoperation and were excluded. Tapes were visualized in the remaining 67 (54%) women. The subjective and objective cure rates in this sub-cohort were 67% (45/67) and 77% (52/67), respectively. In these 67 women the mean distances from the bladder neck to the proximal edge of the tape (BNTD) during Valsalva maneuver were significantly higher in cured women compared to the not-cured women (11.2 vs. 9.4mm). The distance between tape and urethra (TUD) was significantly lower in cured vs. not cured patients (2.6 vs. 4.1mm). All women with a TUD of >5mm (n = 5) were incontinent. Tape position was not associated with overactive bladder symptoms.ConclusionsTape position near the bladder neck and large distance to the urethra is associated with incontinence 10 years after TVT-O.
Highlights
IntroductionMidurethral tapes can be placed in a retropubic or transobturator position
Stress urinary incontinence (SUI) affects up to 25% of women and can severely impact quality of life (QoL)[1,2] The lifetime risk of SUI surgery for women in the United States has recently been estimated as 13.6%[3], and the number of procedures to correct urinary incontinence have increased during the last decades [4]. pelvic floor muscle therapy is recommended as first line therapy of SUI, it has been shown to be inferior to midurethral tape surgery, which is the mainstay of surgical treatment for SUI [5].Midurethral tapes can be placed in a retropubic or transobturator position
The subjective and objective cure rates in this sub-cohort were 67% (45/67) and 77% (52/67), respectively. In these 67 women the mean distances from the bladder neck to the proximal edge of the tape (BNTD) during Valsalva maneuver were significantly higher in cured women compared to the not-cured women (11.2 vs. 9.4mm)
Summary
Midurethral tapes can be placed in a retropubic or transobturator position. While transobturator tapes have a higher risk of repeat surgery, retropubic tapes are associated with higher incidence of bladder injuries and postoperative voiding difficulties [6,7]. Overall, both tapes have high short-term and long-term success rates [7,8,9,10,11,12,13]. No studies have addressed sonography findings in long-term follow-up studies of patients after midurethral tape surgery. The study addressed subjective outcome, QoL, patient satisfaction, and sexual health
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