Suburethral Tape Research Articles

Ten-Year Followup after Tension-Free Vaginal Tape-Obturator Procedure for Stress Urinary Incontinence

Suburethral tapes are a standard surgical treatment for stress urinary incontinence. The aim of the study was to evaluate subjective and objective cure rates 10 years after a tension-free vaginal tape-obturator procedure. All 124 patients who underwent the tension-free vaginal tape-obturator procedure at a total of 2 centers in 2004 and 2005 were invited for followup. Objective cure was defined as a negative cough stress test at 300 ml. Subjects completed KHQ (King's Health Questionnaire), IOQ (Incontinence Outcome Questionnaire), FSFI (Female Sexual Function Index Questionnaire) and PGI-I (Patient Global Impression of Improvement). Overall, 55 of 112 women (49%) who were alive were available for clinical examination and 71 (63%) completed the questionnaires. The objective cure rate in the 55 women examined clinically was 69%, 22% were not cured and 9% (5) had undergone reoperation for recurrent or persistent stress urinary incontinence. Treatment was counted as having failed in these 5 women for study purposes. Subjective cure was reported by 45 of 71 women (64%). Three patients (5%) had vaginal tape extrusion at the time of clinical examination. Extrusion in all of them was small and asymptomatic, and did not require treatment for a cumulative extrusion rate of 7%. Six women (9%) had undergone reoperation for tension-free vaginal tape-obturator associated complications and 18 (26%) experienced de novo overactive bladder. Subjective and objective cure rates 10 years after the tension-free vaginal tape-obturator procedure were 69% and 64%, respectively. The vaginal extrusion rate in this study was slightly higher than in other series but major long-term complications appeared to be rare.

Does age affect the outcome of suburethral tape surgery? The importance of national registries in answering bigger questions.

The objective of this article was to use the British Society of Urogynaecology (BSUG) database to assess the impact of age on success rates and insertion complications of suburethral tapes for primary procedures using the Patient Global Impression of Improvement (PGII) as the primary endpoint. We carried out a retrospective analysis of data at a national level (BSUG database) using PGII as the primary outcome measure. Secondary outcomes included improvement in stress incontinence and complications from surgery. All episodes of suburethral tapes on the database were extracted and analysis was by decade of life. A total of 7,600 cases were identified on the database, of which 757 were in women over 70years of age, with 119 in women over 80. Just over 80% of the cases on the database involved retropubic and just under 20% transobturator tapes. Short-term follow-up was available for 54% of the cases. The PGII remained high in all age groups, but did decrease slightly with age, with more than 90% of women under 50 scoring highly, which reduced to 70% in those over 80. Improvement in stress incontinence was globally high, with 98% scoring highly in the women aged under 50 and 85% in the 80+ group. This suggests that the suburethral tapes worked well in treating stress incontinence. Reassuringly, complications did not increase with age, although short-term voiding difficulties were higher with increasing age. Contributing to national databases gives useful information that may be difficult to ascertain from RCTs. Suburethral tapes appear to have good efficacy and low complications with increasing age.

907 Evaluation of sexual function and quality of life in women treated for stress urinary incontinence: Tension-free transobturator suburethral tape vs single incision sling

907 Evaluation of sexual function and quality of life in women treated for stress urinary incontinence: Tension-free transobturator suburethral tape vs single incision sling

Evaluation of Sexual Function and Quality of Life in Women Treated for Stress Urinary Incontinence: Tension-Free Transobturator Suburethral Tape Versus Single-Incision Sling.

The aim of this study is to investigate the change in quality of life (QoL) and sexual function in women treated for pure stress urinary incontinence (SUI) using tension-free transobturator suburethral tape (TVT-O) and single-incision sling (SIS) procedures. From December 2013 to January 2015, a total of 48 female patients with pure SUI and normotonic urethra were consecutively enrolled and randomized into two treatment groups: TVT-O versus SIS. Both groups were homogeneous in the preoperative evaluation of age, body mass index, comorbidities, and pregnancies. Exclusion criteria included urge urinary incontinence, neurogenic bladder, previous surgery for incontinence, and mental or neurological disorders. The female sexual function and QoL were assessed preoperatively and postoperatively (3-12 months follow-up), using the Female Sexual Function Index (FSFI) and the International Consultation on Incontinence Questionnaire. A total of 42 patients completed both the questionnaires (21 patients in the TVT-O group and 21 patients in the SIS group, whereas 6 patients were lost to follow-up). Of the 19/21 (90.4%) of patients who successfully underwent the SIS procedure, 17 (80.9%) reported a complete resolution of SUI, whereas 2 (9.5%) reported an improvement in urinary incontinence at follow-up. In the TVT-O group, 18/21 (85.7%) of patients reported complete recovery, whereas 4.1% patients reported an improvement in the incontinence. The FSFI score increased significantly in both the SIS groups (from 23:51 ± 3.78 to 27.42 ± 3.34; p < 0.001) and TVT-O group (from 23.96 ± 5:56 to 28.09 ± 3.62) with no statistically significant differences between the two treatment groups. In our study, both slings showed a high rate of continence without any major complications. The sexual function also improved sharply in all the six FSFI domains, with no statistically significant difference between the two treatment groups.

Transvaginal treatment of anterior or central urogenital prolapse using six tension-free straps and light mesh.

To evaluate the feasibility, efficacy, complications, and outcomes of treatment of anterior or central compartment urogenital prolapse by placement of an anteroposterior 22-g/m(2) mesh with six straps through one anterior vaginal incision. In a prospective study, patients treated for urogenital prolapse at a center in France between February 2008 and June 2011 were enrolled. Previous treatments, related interventions, intraoperative and postoperative complications, and anatomic outcomes were recorded during 3years of follow-up. Failure was defined as recurrence of prolapse of stage II or higher according to the Pelvic Organ Prolapse Quantification system. Overall, 74 patients were included. Preoperatively, 55 (74%) patients had stage III cystocele, 13 (18%) had stage IV cystocele, and 44 (59%) had associated uterine prolapse of at least stage II. Postoperative hematoma occurred in three patients and vaginal exposure in two patients. There were no cases of visceral injury. Vaginal comfort improved postoperatively: 68 (92%) patients were satisfied with the outcome and there were no cases of de novo dyspareunia. Seventeen (23%) patients subsequently had stress urinary incontinence that was treated by placement of suburethral tape. The anatomic outcomes were satisfactory for 72 (97%) women, including sexually active patients. Transvaginal prolapse repair by placement of an anteroposterior six-strap 22-g/m(2) mesh was feasible and effective with satisfactory 3-year outcomes.

Does the Patients Age have an Influence on the Outcome of CESA (Cervico-Sacropexy) and VASA (Vagino-Sacropexy) for the Treatment of Urinary Incontinence in Women?

About 40% of all women will develop urinary incontinence during their life, usually starting around the age of 50 years. It usually starts with the spontaneous undesired loss of urine during increased intra-abdominal pressure (coughing or sneezing) and will continue in even shorter time intervals to reach the toilet “just in time”. In its ultimate form the patient has no control anymore about her voiding function and is “always wet”. While previously only SUI, the “mild” form of urinary incontinence, could effectively be treated by the replacement of the PUL using suburethral tapes we now have the chance to cure also the moderate and severe forms of urinary incontinence. With the bilateral replacement of the USL by the CESA and VASA operations over 50% of all patients were cured. When the remaining patients received an additional TOT 8/4 the cure rate was increased up to more than 80% of the patients. We observed that the number of cured patients decreased with increasing age. While patients younger than 60 years have a nearly 90% chance of cure this chance decreases down to 65% for those patients older than 70 years. The fact that continence could be reestablished by CESA / VASA and a TOT 8/4 demonstrates that urinary incontinence can be cured by surgery in most patients. We are not certain which ageing effects were responsible for the diminishing cure rate with increasing age. As all our other calculations did not indicate any responsible factor for this observation, we probably did not measure the responsible factor so far.

TOT 8/4: A Way to Standardize the Surgical Procedure of a Transobturator Tape.

Suburethral tapes are placed “tension-free” below the urethra. Several studies reported considerable differences of the distance between urethra and tape. These distances ranged from 1 to 10 mm amongst different patients. This either caused urethral obstruction or had no effect on urinary incontinence. Therefore, we decided to standardize the procedure by placing a Hegar dilator of 8-millimeter diameter in the urethra and another Hegar dilator of 4-millimeter diameter between the urethra and the tape during transobturator tape placement. Using that simple technique, which we named “TOT 8/4,” we observed that 83% of the tapes were placed in the desired distance between 3 and 5 millimeters below the urethra.

Comparison of different types of synthetic suburethral tape for the treatment of stress urinary incontinence in women

Comparison of different types of synthetic suburethral tape for the treatment of stress urinary incontinence in women

BANDA SUBURETRAL CON ABORDAJE TRANSOBTURADOR(TOT), EN EL TRATAMIENTO DE LA INCONTINENCIA URINARIA DE ESFUERZO FEMENINA. NUESTRA EXPERIENCIA

Objetivos: Analizar los factores predisponentes que influyen en la incontinencia urinaria de esfuerzo (IUE). Valorar la eficacia y seguridad de la técnica de banda suburetral con abordaje transobturador (TOT) en el tratamiento de la IUE femenina. Diseño: Estudio observacional retrospectivo. Institución: Servicio de Ginecología y Obstetricia, Xarxa Sanitaria i Social de Santa Tecla. Hospital Vendrell. Red sanitaria publica. Tarragona. Cataluya. Espanya. Participantes: Pacientes con diagnóstico de IUE. Intervenciones: Sesenta pacientes con diagnóstico de IUE fueron tratadas entre octubre 2006 y febrero 2010. Se utilizó tres tipos de malla de casas comerciales diferentes (Aris, Gynecare y Monarc). La técnica de colocación en la mayoría de las pacientes fue out–in con abordaje transobturador, a excepción de Gynecare, cuya colocación fue in–out. Principales medidas de resultados: Curación de la IUE. Resultados: La edad media fue 56 años, el antecedente más frecuente la obesidad, con 50%, seguida de hipertensión arterial 32% e histerectomía 27%. El índice de curación (definida como ausencia absoluta de escape, tanto en la anamnesis como en la exploración física) fue al mes de la cirugía 83%, al año 83% y a seguimiento a más de un año de 70%. Un 12% necesitó corrección de otros defectos del compartimento vaginal. No se presentó alguna complicación intraoperatoria. El tiempo de ingreso hospitalario fue de 0,8 día. En el postoperatorio ocurrieron 10% de retención urinaria, 8% de tenesmo vesical, 8% urgencia de novo, 2% extrusión de malla y 3% dispareunia. Conclusiones: Nuestros resultados son equiparables a los publicados en la literatura. Bajo nuestra experiencia, el TOT se presenta como una técnica segura, con una alta eficacia en el tiempo para el tratamiento de la IUE en pacientes con uretra móvil, y con una tasa baja de complicaciones. Se trata de una técnica con una curva de aprendizaje corta y la posibilidad de realizarla en régimen de cirugía mayor ambulatoria.

Urinary tract infections in women with stress urinary incontinence treated with transobturator suburethral tape and benefit gained from the sublingual polibacterial vaccine.

Stress urinary incontinence (SUI) and recurrent urinary tract infections (RUTIs) are highly prevalent diseases. Our purpose was to investigate the relationship between RUTIs and surgical correction of SUI with transobturator suburethral tape (TOT) and to describe the benefit gained from a sublingual polibacterial preparation on RUTIs developed after TOT. A retrospective study was performed on 420 women who underwent TOT surgery due to SUI between April 2003 and October 2011. Group A: patients without urinary tract infections (UTIs) before TOT (n = 294). Group B: patients with UTIs before TOT (n = 126). age, personal history, number of UTIs/month prior to and after surgery, appearance of urgent urinary incontinence (UUI) with or without UTIs, response to International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Short Form 36 (SF-36) questionnaires. Group A: 85% dry; 5% UUI; 4% de novo UTIs with good response to antibiotics over 6 days. No RUTIs during the follow-up period, 2% with sporadic UTIs. Group B: 47.61% RUTIs; 52.39% sporadic UTIs; greater incidence of diabetes mellitus (p < 0.0025) and smoking (p < 0.0031) than group A. After TOT: 79.36% dry; 10% RUTIs. After treatment with antibiotics for 6 days and bacterial preparation for 3 months, 82% of patients did not have a UTI anymore. Postoperative cystourethrogram revealed 38% of nondiagnosed cystoceles before TOT. No patient had a postvoiding volume greater than 100 cm(3) after TOT. Improvement of ICIQ-SF (p < 0.001) and SF-36 (p < 0.0004) in both groups. After eliminating bias associated with the tape, the technique and the surgeon's skills, SUI correction may decrease the number of UTIs and improve the quality of life. UTIs disappeared in 82% of patients with RUTIs after TOT.

Mini-slings can cause complications.

Single-incision mini-slings (SIMS) have been advocated to avoid the complications of transobturator and retropubic midurethral slings. We present a series of SIMS complications and their outcome after vaginal removal at a tertiary care center. Following Institutional Review Board approval, a prospective database of consecutive women who underwent SIMS removal for complications and had a minimum follow-up of 6 months was reviewed. Patient-reported outcomes were assessed by main symptom category. In addition, an ideal outcome or cure was defined as continent, pain-free, sexually active if active preoperatively, and not requiring additional medical or surgical therapy. Of 23 women, 17 met inclusion criteria. Presenting symptoms were varied but dominated by incontinence (14), pelvic pain (11), dyspareunia (10), and obstructive urinary symptoms/urinary retention (5), with 76 % presenting with more than one complaint. Type of SIMS included MiniArc™ (11), Solyx™ (4), and TVT-Secur™ (2). At a mean follow-up of 17 ± 9 (range 7-44) months after SIMS removal, six (35 %) women were cured of their presenting complaint. Among the 11 women with pelvic pain, 6 had resolution of pain, 2 improvement, and 3 persistent pain. Six of seven women who were sexually active beforehand resumed sexual activity. Dyspareunia persisted in three women. Of 14 with incontinence, 8 had cure or improvement, and obstructive symptoms resolved in 4 of 5. This series outlines several complications with SIMS, similar to what has been reported with other suburethral synthetic tapes. Therefore, caution is required and patient counseling is important.

Outcome of Transvaginal Mesh and Tape Removed for Pain Only

Because there is reluctance to operate for pain, we evaluated midterm outcomes of vaginal mesh and synthetic suburethral tape removed for pain as the only indication. After receiving institutional review board approval we reviewed a prospective database of women without a neurogenic condition who underwent surgery for vaginal mesh or suburethral tape removal with a focus on pain as the single reason for removal and a minimum 6-month followup. The primary outcome was pain level assessed by a visual analog scale (range 0 to 10) at baseline and at each subsequent visit with the score at the last visit used for analysis. Parameters evaluated included demographics, mean time to presentation and type of mesh or tape inserted. From 2005 to 2013, 123 patients underwent surgical removal of mesh (69) and suburethral tape (54) with pain as the only indication. Mean followup was 35 months (range 6 to 59) in the tape group and 22 months (range 6 to 47) inthe mesh group. The visual analog scale score decreased from a mean preoperative level of 7.9 to 0.9 postoperatively (p = 0.0014) in the mesh group and from 5.3 to 1.5 (p = 0.00074) in the tape group. Pain-free status, considered a score of 0, was achieved in 81% of tape and 67% of mesh cases, respectively. No statistically significant difference was found between the groups. When pain is the only indication for suburethral tape or vaginal mesh removal, a significant decrease in the pain score can be durably expected after removal in most patients at midterm followup.

Diagnostik bei Belastungsinkontinenz des Mannes

Male lower urinary tract symptoms (LUTS) occur more frequently with increasing age. LUTS can either be caused by benign prostatic syndrome (BPS) and consecutive subvesical obstruction as well as detrusor hyperactivity. On the other hand, stress urinary incontinence is mostly seen after surgical intervention in the pelvis like radical prostatectomy. Also high volume centers report persisting incontinence rates of 2-4 % after radical prostatectomy.The diagnostic procedure in men with LUTS is divided in two steps: basic diagnostics, followed by a conservative treatment option, and extended diagnostic procedures including measurement of bladder pressure during filling and voiding. In addition, radiologic examinations, including voiding cystouretherogram, retrograde cystogram, CT scan, MRI scan, are added according to the severity of the symptoms and the scheduled surgical procedure. According to the guidelines of the DGU, EAU, AUA, and ICS, this extended examination is also mandatory prior to any surgical procedure like suburethral tapes, artificial sphincters, and sacral foramen neuronal stimulators.

The Effects of Suburethral Tape on the Symptoms of Overactive Bladder.

Suburethral tension-free vaginal tape is used for the treatment of stress urinary incontinence with a high success rate. Often patients report having stress incontinence, as well as co-existing micturition problems which are attributable to overactive bladder syndrome (OAB). The present study examines the effect of suburethral tape on the symptoms of OAB. In the study, we used the transobturator vaginal tape inside-out technique (TVT-O). Materials and Methods: 53 patients were included in the study, all had proven urodynamic stress incontinence and symptoms of overactive bladder. The patients were examined preoperatively and 3 months after the TVT-O placement. Results: The individual OAB symptoms improved significantly, with urinary frequency and urge incontinence improving more than nocturia. The frequency of micturition decreased on average from 16.1 to 10.1 episodes/24 hours, while nocturnal frequency of micturition decreased from 2.2 to 1.1. Not a single patient experienced the simultaneous worsening of all three measured variables, however 19 % of patients did report their simultaneous disappearance. Their quality of life that had been affected by OAB was measured on the basis of validated questionnaires, and found to have improved significantly. Only 28 % of patients reported a desire for drug treatment of OAB symptoms following tape placement. Conclusions: TVT-O placement leads to a significant improvement of the symptoms of overactive bladder syndrome. Patient quality of life - which was affected by OAB - was also enhanced by the tape placement. This accounts for a substantial share of the overall success of the suburethral tape.

Early complications of the transobturator tape and mini sling procedure

Mesh extrusion was detected in 6 (4.6%) and 18 ( 10.9 %) cases of the TOT and mini sling group, respectively. There was a statistically significant difference about mesh extrusion (p: 0.036). Ten patients (6.1%) and eight cases (6.15%) had de novo urge incontinence responsed to medical theraphy in the post-operative follow-up in the mini sling and TOT groups, respectively. Two patients (1.2%), who underwent the mini sling procedure, required sling section due to prolonged bladder outlet obstruction. Significant infection complication due to operation was not detected. Three and one cases complained of thigh pain in the TOT and mini sling group, respectively. Conclusions: Mini sling procedure, when compared with suburethral tape,had similar complication rates except relatively high mesh erosion rates with comparable success rates. All cases should be carefully followed for late complications.

Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women

Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women

Transobturator tape for female stress urinary incontinence: preoperative valsalva leak point pressure is not related to cure rate or quality of life improvement.

PurposeWe investigated whether the Valsalva leak point pressure (VLPP) is valuable for predicting postoperative outcome measurement after transobturator suburethral tape (TVT-O) implantation for treating stress urinary incontinence (SUI) in women.Materials and MethodsA total of 204 female patients who underwent TVT-O placement for treatment of SUI from March 2008 to February 2012 were enrolled in this retrospective study. All patients completed the incontinence quality of Life questionnaire (I-QoL), a self-reported quality of life measure specific to urinary incontinence, and the cure rate of incontinence was measured before and 6 months after surgery. Cure was defined as no leakage of urine postoperatively both subjectively and objectively. We compared pre- and postoperative I-QoL scores according to preoperative VLPP and Stamey grade.ResultsThe numbers of patients with Stamey grades I, II, and III were 99 (48.5%), 84 (41.2%), and 21 (10.3%), respectively. A total of 30 (14.7%), 87 (42.6%), and 87 patients (42.6%) showed VLPP≤60, 60<VLPP≤90, and VLPP>90 cm H2O, respectively. Preoperative VLPP was not significantly different according to preoperative I-QoL or change in I-QoL after surgery. However, I-QoL after surgery improved in patients with a high preoperative Stamey grade (p=0.001).ConclusionsVLPP was not a factor related to surgical outcome from the midurethral sling procedure. Stamey grade rather than VLPP was important for predicting subjective quality of life and improved incontinence-related quality of life after surgery.

Long-term outcome of transobturator suburethral tape procedure for treatment of female stress urinary incontinence.

Objective:The aim is to evaluate the long-term safety and efficacy of transobturator tape (TOT) procedure in the treatment of women with stress urinary incontinence (SUI) by subjective and objective measures.Patients and Methods:A total 48 women with SUI underwent the TOT procedure during the period from December 2005 to February 2008. The follow-up period ranged between 60 and 84 months (mean 71 months). Mean age was 44.21 ± 7.52 (range: 30-58). Preoperative and early postoperative data were retrieved from the patient's medical files. Follow-up evaluation was carried out every 3 months during the 1st year and yearly afterwards by history taking (including incontinence and quality-of-life questionnaire), clinical examination, urine analysis, abdominopelvic ultrasonography, and urodynamic studies when indicated.Results:At 12-month follow-up, the cure, improvement, and failure rates were 39 patients (81.25%), 5 (10.42%) and 4 (8.33%), respectively. The corresponding rates at the last follow-up were 38 (79.15%), 5 (10.42%) and 5 (10.42%) respectively. The postvoid residual urine and peak flow rates did not differ significantly between the preoperative values and at the last follow-up. The complication rates after a mean 71-month included one patient with voiding difficulty and two patients with de novo urgency. No case was recorded with retention of urine or erosion.Conclusions:Transobturator tape procedure appeared to be effective minimally invasive procedure for SUI with low rate of complication and good long-term outcome.

E.07.02 Clinical use of psychotropic drugs in youth – interests and pitfalls

Stress urinary incontinence (SUI) is a highly prevalent dysfunction in middle-aged and elderly women. One recent technique places a sub-urethral tape passed through the transobturator foramen. Efficacy and quality of life were assessed after five years of treatment with the transobturator technique in women suffering SUI. This evaluation followed a previous control at the first year post-intervention.Sixty-three women were assessed five years after operation with the transobturator technique. Additionally, twenty-nine women of these women had undergone pelvic floor reconstruction due to different forms of genital prolapse. Quality of life (QoL) was assessed by the Urogenital Distress Inventory-6 (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7) tests.Subjective and objective cure or improvement, complications, and changes in QoL.Fifty women (79%) remained cured, as assessed by the cough test. Eighteen women (28%) reported urine leakage during physical activity. These objective and subjective data were worse than those reported at the one-year follow-up. De novo urge urinary incontinence was reported by 11 women or 17%. Nine of these women had undergone additional pelvic floor surgery. The QoL tests confirmed that cure or improvement was achieved in 78% (49) (UDI-6) and 79% (50) (IIQ-7) of the women.The transobturator tape procedure resulted in acceptable rates of efficacy after five years. Moreover, QoL tests showed cure or improvement in almost four of five women. Nonetheless, women should be informed of the risk of de novo urinary urgency incontinence and the progressive loss of efficacy with time.

Severe adolescent female stress urinary incontinence (SAFSUI): case report and literature review

Severe adolescent female stress urinary incontinence (SAFSUI) can be defined as female adolescents between the ages of 12 and 17 years complaining of involuntary loss of urine multiple times each day during normal activities or sneezing or coughing rather than during sporting activities. An updated review of its likely prevalence, etiology, and management is required. The case of a 15-year-old female adolescent presenting with a 7-year history of SUI resistant to antimuscarinic medications and 18months of intensive physiotherapy prompted this review. Issues of performing physical and urodynamic assessment at this young age were overcome in order to achieve the diagnosis of urodynamic stress incontinence (USI). Failed use of tampons was followed by the insertion of (retropubic) suburethral synthetic tape (SUST) under assisted local anesthetic into tissues deemed softer than the equivalent for an adult female. Whereas occasional urinary incontinence can occur in between 6% and 45% nulliparous adolescents, the prevalence of non-neurogenic SAFSUI is uncertain but more likely rare. Risk factors for the occurrence of more severe AFSUI include obesity, athletic activities or high-impact training, and lung diseases such as cystic fibrosis (CF). This first reported use of a SUST in a patient with SAFSUI proved safe and completely curative. Artificial urinary sphincters, periurethral injectables and pubovaginal slings have been tried previously in equivalent patients. SAFSUI is a relatively rare but physically and emotionally disabling presentation. Multiple conservative options may fail, necessitating surgical management; SUST can prove safe and effective.