Tape In Women Research Articles

Stretching of the anterior fascial tape in women after a caesarean section

Introduction. The cesarean section rate in the 21st century has significantly increased compared to the previous century. Consequences related to the existence of a scar after a cesarean section may contribute to various discomforts in the abdominal, back, or pelvic regions. Aim of the study. The research hypothesis posited that the application of stretching therapy of the anterior fascial band has an impact on and is associated with the scar texture after a cesarean section. Study materials and methodology. Eight women, 3-4 months postpartum, with an average age of 27.5 ± 4.17 years, participated in the study. The MyotonPro device was utilized to assess the biomechanical properties of the tissue around the scar. The women performed stretching exercises for 2 months, twice a week. One session per week was supervised by the researcher, and during the other session, participants performed the assigned exercises independently. Measurements with the MyotonPro device were repeated after 8 weeks. Results. A strong and positive correlation was observed between: cs_2 and cs_1 r = 0.88, cs_2 and ls_1 r = 0.96, cs_2 and rs_1 r = 0.82, ls_2 and ls_1 r = 0.97, rs_2 and rs_1 r = 0.96. Conclusions. Engaging in stretching exercises has a positive impact on improving the texture of scar tissue.

Functional outcomes of vaginal surgery for urethral extrusion of mid-urethral tape in women.

We aim to determine the presentation of and immediate and longer-term outcomes of vaginal surgical excision of urethral extrusion of mid-urethral tape (MUT). We performed a retrospective analysis of all patients with urethral extrusion of MUT having vaginal surgical excision between 2007 and 2018. The MUT was removed either partially (via vaginal approach) or completely (via combined vaginal and laparoscopic approach). Functional outcomes and any re-interventions are described. Thirty-four patients of median age 53 (range 34-82)years were identified. Preoperative symptomatic recurrent/persistent urinary incontinence was present in 29/34(85%) with 24/34(71%) women having recurrent/persistent stress urinary incontinence (SUI) or stress predominant mixed urinary incontinence (s-MUI) on urodynamics. Vaginal surgical excision was performed alone in 33/34(97%) women and in combination with laparoscopic removal of abdominopelvic MUT in 1/34(3%) woman. In the longer term vaginal/urethral pain resolved or improved in all 15/15(100%) patients presenting with this complaint whilst patient reported poor flow resolved in 8/9 (89%) women. Twenty-eight of 34 women (82%) had persistent/recurrent SUI or s-MUI following MUT excision. Twenty-four of 34 women (71%) had further SUI surgery with cure or improvement of SUI in 20/24 (83%) patients. The outcome of vaginal surgical excision of the MUT was cure or improvement of pain in 100% and resolution of poor flow in 89% women. Recurrent/persistent SUI or s-MUI was present in 82% following removal as compared to 71% women prior to removal. Of the 71% of women electing to have further surgery for recurrent/persistent SUI/s-MUI, 83% were dry or improved afterwards.

Recurrent stress urinary incontinence : Interventions for treatment after failed minimally invasive use of synthetic midurethral tape in women

Recurrent stress urinary incontinence : Interventions for treatment after failed minimally invasive use of synthetic midurethral tape in women

Female sexual function after transobturator tape in women with urodynamic stress urinary incontinence

We evaluate quality of life and sexual function before and after transobturator tape procedure (TOT) using the International Consultation on Incontinence Questionnaire (ICIQ -SF) and Female Sexual Function Index (FSFI). Between 2008 and 2013, 92 patients with stress urinary incontinence (SUI) underwent TOT procedure. A total of 81 patients were sexual active and enrolled in the study. All patients completed the Turkish translation ICIQ -SF and FSFI forms before and 1, 3, 6, 12 months after surgery. To evaluate the impact of incontinence and TOT success on sexual function, we compared patients that were dry after surgery and patients still incontinent and/or facing complication.All 81 patients completed the study protocol. The total FSFI score was 21.3 ± 7.9 and statistically significant when compare with preoperative total FSFI score (16.2 ± 7.9). The mean postoperative ICIQ -SF score (2 ± 2.9) was also significantly lower than the mean preoperative ICIQ -SF score (17.3 ± 1.8). Complications were encountered in 13 patients, including vaginal erosion (4 patients), de novo urge incontinence (4 patients), vesico-vaginal fistula (1 case), cysto-rectocele (1 case) and high postoperative residue requiring mesh excision (3 patients). Continent (n = 68) patients had a significantly better postoperative total FSFI and ICIQ -SF score against patients who had urine loss.Our study found a significant improvement of FSFI score and ICIQ -SF score after TOT operation in women with SUI. Additionally, urine loss due to complications was related with worsened FSFI score and ICIQ score compare with healthy patient’s scores.

Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial

We set out to determine if insertion of a retropubic tension-free vaginal tape (TVT) sling at the time of pelvic organ prolapse surgery improves continence outcomes in women with pre-operative occult stress incontinence (OSI) or asymptomatic urodynamic stress incontinence (USI). We conducted a randomised controlled study of prolapse surgery with or without a TVT midurethral sling. The pre- and post-operative assessment at 6 months included history, physical examination and urodynamic testing. Quality of life (QOL) and treatment success was assessed with the UDI-6 SF, IIQ-7 SF and a numerical success score. The primary outcome was symptomatic stress urinary incontinence (SUI) requiring continence surgery (TVT) at 6 months. Long-term follow-up continued to a minimum of 24 months. Secondary outcomes were quality of life parameters. Eighty women received prolapse surgery alone (n = 43) or prolapse surgery with concurrent TVT (n = 37). Six months following prolapse surgery 3 out of 43 (7 %) patients in the no TVT group requested sling surgery compared with 0 out of 37 (0 %) in the TVT group (ARR 7 % [95 %CI: 3 to 19 %], p = 0.11). After 24 months there was one further participant in the no TVT group who received a TVT for treatment of SUI compared with none in the TVT group (4 out of 43, 9.3 % versus 0 out of 37; ARR 9.3 % [95 %CI: -1 to 22 %], p = 0.06). Both groups showed improvement in QOL difference scores for within-group analysis, without difference between groups. These results support a policy that routine insertion of a sling in women with OSI at the time of prolapse repair is questionable and should be subject to shared decision-making between clinician and patient.

Plantarflexor and Dorsiflexor Activation during Inclined Walking with and without Modified Mobilization with Movement Using Tape in Women with Limited Ankle Dorsiflexion

[Purpose] This study compared the EMG activities of the plantarflexor and dorsiflexor muscles during inclined walking with and without modified mobilization with movement (modified MWM) using tape in women with limited ankle dorsiflexion. [Subjects] Fifteen women with limited dorsiflexion in their feet (22 feet in total) were recruited for this study. [Methods] The subjects walked with and without modified MWM using tape on a treadmill at 6 degrees with a speed of 1.25 m/s for 5 minutes. The EMG activities of the medial gastrocnemius (GCM) and tibialis anterior (TA) muscles were measured using a surface EMG system. [Results] During incline walking with modified MWM using tape, the mean EMG activity of the GCM significantly increased, and that of the TA decreased between heel strike and heel off. There was no difference between heel off and toe off in the two muscles. [Conclusions] Modified MWM using tape on the talus during incline walking could alter the muscle activities of the GCM and TA between heel strike and heel off in women with limited ankle dorsiflexion.

Three-Year Follow-Up of Tension-Free Vaginal Tape Compared With Transobturator Tape in Women With Stress Urinary Incontinence and Intrinsic Sphincter Deficiency

To compare the efficacy of tension-free vaginal tape (TVT) to transobturator tape in the treatment of women with stress urinary incontinence (SUI) and intrinsic sphincter deficiency at 3-year follow-up. One hundred sixty-four women were randomized to either TVT or transobturator tape after diagnosis of urodynamic stress incontinence and intrinsic sphincter deficiency. Concomitant pelvic organ prolapse surgery was not an exclusion criterion. The primary outcome assessed at 3-year follow-up was symptomatic stress incontinence requiring repeat surgery. Secondary outcomes were quality-of-life parameters assessed by validated questionnaires and numerical success score. One hundred sixty-four women were enrolled in the study. At 3 years, 15 of the 75 (20%) women in the transobturator tape group underwent repeat surgery to correct SUI compared with one of the 72 (1.4%) in the TVT group. In other words, if TVT had been used exclusively, repeat surgery would have been avoided in one in six patients. The risk ratio of repeat surgery was 15 (95% confidence interval 2-113; P<.001) times greater in the transobturator tape group. In the transobturator tape group, the median time to repeat surgery was 15.6 months compared with 43.7 months for TVT (P<.001). The quality-of-life outcomes did show an improvement in both groups before and after surgery but no difference between the two slings in the Urogenital Distress Inventory short form, the Incontinence Impact Questionnaire short form, and a patient-rated numerical success score. The long-term cure rates for retropubic TVT are significantly greater than for transobturator tape in women with urodynamic stress incontinence and intrinsic sphincter deficiency. Urethral functions tests such as urethral closure pressure and Valsalva leak point pressures are of value in determining what surgery to perform. Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12608000093381. I.

Recurrent stress urinary incontinence after synthetic mid-urethral sling procedures

Synthetic mid-urethral slings (MUSs) have been widely adopted for female stress urinary incontinence (SUI). Practitioners are encountering increasing numbers of women with recurrent SUI after a failed MUS. Several studies over the past 18 months have reported outcomes for secondary continence procedures in this context and form the basis of this review. Expert consensus supports a trial of conservative therapy for recurrent SUI, although a sound evidence base is lacking. As regards repeat surgical intervention, retrospective studies on repeat synthetic MUSs have demonstrated medium-term cure rates of 60-70%, which is lower than that achieved with primary surgery. Secondary transobturator tape appears inferior to secondary retropubic tape in women with intrinsic sphincteric deficiency. Promising early results have been reported with spiral slings and the adjustable continence procedures, although these interventions are technically more challenging and longer-term follow-up is warranted. Artificial urinary sphincters show high efficacy rates for severe, refractory SUI, although complication rates are higher in women with prior failed MUS. Repeat synthetic MUSs are likely to form the mainstay of secondary continence procedures presently. Longer-term follow-up of promising newer modalities, including adjustable continence therapies, is required. Above all, there is an urgent need for good quality, prospective data to guide practitioners in this growing clinical challenge.

Effectiveness of Tension-Free Vaginal Tape Compared With Transobturator Tape in Women With Stress Urinary Incontinence and Intrinsic Sphincter Deficiency: A Randomized Controlled Trial

OBJECTIVE: To compare efficacy of transobturator tape with tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence in women with intrinsic sphincter deficiency. METHODS: One hundred sixty-four women diagnosed with urodynamic stress incontinence and intrinsic sphincter deficiency with or without concomitant pelvic organ prolapse repair were randomized to receive TVT or transobturator tape. The primary outcome was the presence or absence of urodynamic stress incontinence at 6 months postoperatively. Secondary outcomes were the rate of operative complications, symptomatic stress incontinence requiring further surgery, and quality-of-life questionnaires. RESULTS: Of 180 women eligible to participate, 164 were enrolled and underwent surgery. Of the 138 patients assessed at 6 months with urodynamic studies, 14 of 67 (21%) had urodynamic stress incontinence in the TVT group compared with 32 of 71 (45%) in the transobturator tape group (P=.004), with nine women in the transobturator tape group having repeat sling surgery compared with none in the TVT group. In the intention-totreat analysis, the incident rate difference for request of repeat surgery was 9.7% (95% confidence interval [Cl] 0-19.9); repeat surgery would be requested in one of every six transobturator tape procedures compared with 1 of every 16 TVT procedures. The risk ratio of repeat surgery was 2.6 (95% Cl 0.9-9.3) times higher in the transobturator tape group. CONCLUSION: Retropubic TVT is a more effective operation than the transobturator tape sling in women with urodynamic stress incontinence and intrinsic sphincter deficiency.

Effectiveness of Tension-Free Vaginal Tape Compared With Transobturator Tape in Women With Stress Urinary Incontinence and Intrinsic Sphincter Deficiency: A Randomized Controlled Trial

Effectiveness of Tension-Free Vaginal Tape Compared With Transobturator Tape in Women With Stress Urinary Incontinence and Intrinsic Sphincter Deficiency: A Randomized Controlled Trial

Collagen Injection for Female Urinary Incontinence After Urethral or Periurethral Surgery

We evaluated the result of periurethral collagen injection in incontinent patients after prior urethral surgery. We reviewed the charts of patients who underwent periurethral collagen injection between January 2000 and December 2006 for persistent stress urinary incontinence after a failed suspension procedure or urethral repair. Preoperative assessment included the validated Urogenital Distress Inventory-6 symptom questionnaire, a single global quality of life score, history and physical examination, cystogram while standing and multichannel urodynamics. All patients had a well supported urethra and intrinsic sphincteric deficiency. Outcome measures included questionnaires and 3-dimensional urethral ultrasound at 6 weeks, 6 to 12 months and yearly thereafter. In patients who were still symptomatic after the first injection a repeat injection was considered when there was asymmetrical or low collagen volume on ultrasound, and another therapy was considered when ultrasound findings were adequate. In 31 consecutive patients Urogenital Distress Inventory-6 question 3 and quality of life scores decreased after collagen injection (mean volume 5.5 cc). Baseline postoperative collagen volume on ultrasound was 2.6 cc (range 0.8 of 4.8). Of the patients 93% considered themselves clinically improved or cured, 17 of 31 required only 1 injection with a symmetrical configuration in 83%, while 8 received 1 or 2 more injections because of an asymmetrical configuration (75%) and/or low volume. Despite a mean collagen volume of 3.2 cc (range 2 to 4.3) 6 women with persistent stress urinary incontinence underwent a pubovaginal sling procedure. Eight of 25 patients requiring only collagen had stable collagen volume for 2 years without repeat injection. Collagen injection is a viable option with satisfactory results in this complex population.

Effectiveness of Tension-Free Vaginal Tape Compared With Transobturator Tape in Women With Stress Urinary Incontinence and Intrinsic Sphincter Deficiency

To compare efficacy of transobturator tape with tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence in women with intrinsic sphincter deficiency. One hundred sixty-four women diagnosed with urodynamic stress incontinence and intrinsic sphincter deficiency with or without concomitant pelvic organ prolapse repair were randomized to receive TVT or transobturator tape. The primary outcome was the presence or absence of urodynamic stress incontinence at 6 months postoperatively. Secondary outcomes were the rate of operative complications, symptomatic stress incontinence requiring further surgery, and quality-of-life questionnaires. Of 180 women eligible to participate, 164 were enrolled and underwent surgery. Of the 138 patients assessed at 6 months with urodynamic studies, 14 of 67 (21%) had urodynamic stress incontinence in the TVT group compared with 32 of 71 (45%) in the transobturator tape group (P=.004), with nine women in the transobturator tape group having repeat sling surgery compared with none in the TVT group. In the intention-to-treat analysis, the incident rate difference for request of repeat surgery was 9.7% (95% confidence interval [CI] 0-19.9); repeat surgery would be requested in one of every six transobturator tape procedures compared with 1 of every 16 TVT procedures. The risk ratio of repeat surgery was 2.6 (95% CI 0.9-9.3) times higher in the transobturator tape group. Retropubic TVT is a more effective operation than the transobturator tape sling in women with urodynamic stress incontinence and intrinsic sphincter deficiency. www.actr.org.au, Australian New Zealand Clinical Trials Registry, ACTRN12608000093381 I.

Tension-Free Transvaginal (TVT) and Transobturator (TOT) Tapes in Women with Multiple Failed Incontinence Procedures or Complex Urogynaecological Intervention

Objectives: We report the outcomes of transvaginal (TVT)/transobturator (TOT) tape in women with multiple or complex urogynaecological intervention and persistent stress urinary incontinence (SUI). Patients and methods: Thirty-seven patients with multiple procedures (median 3) or complex urogynaecological intervention for SUI, McGuire classified on videourodynamics, underwent TVT ( n = 26) or TOT ( n = 11) placement. Patients categorised outcome as excellent, good or poor. Excellent was defined as dry, asymptomatic and completely satisfied. Good was defined as no SUI but residual or de novo urgency, or lack of complete satisfaction. Poor was defined as minimal improvement of symptoms. All patients with residual symptoms underwent repeat video-urodynamics. Results: Mean follow-up was 37 months. Thirty-two patients (86%) were cured of SUI. According to the outcome definitions 46% were excellent, 30% good and 24% poor. Of six patients with McGuire type III SUI, five (83.3%) had persistent SUI, accounting for all with persistent SUI. Bladder perforation and de novo urgency occurred in 11.5% and 19.2% of TVT, but none of those with TOT. Temporary voiding difficulty occurred in 11.5% TVT and 9.1% TOT. Protracted retention occurred in two TVT cases, of which one required tape division. Conclusions: TVT/TOT cured SUI in 86% of patients with multiple SUI procedures or complex urogynaecological intervention, with minimal morbidity. Subjective outcomes were less than objective outcomes mainly due to urgency. The TOT route reduced the risk of bladder injury and de novo urgency. Type III SUI on preoperative urodynamics predicted failure.

Urodynamic Measures Do Not Predict Stress Continence Outcomes After Surgery for Stress Urinary Incontinence in Selected Women

We determined the prognostic value of preoperative urodynamic results in patients with stress urinary incontinence. In a 9-center surgical trial, women with stress urinary incontinence were randomized to a Burch or pubovaginal sling procedure. Women were eligible for the study if they had predominant stress urinary incontinence symptoms, a positive cough stress test, a bladder capacity more than 200 ml and urethral hypermobility. Preoperative free uroflowmetry, filling cystometry and pressure flow studies were performed in all. Overall treatment success required a negative pad test, no urinary incontinence on a 3-day diary, a negative stress test, no self-reported stress urinary incontinence symptoms and no re-treatment for stress urinary incontinence. Stress specific success required all of the last 3 criteria. We examined urodynamic measures, and whether the presence of urodynamic stress incontinence, the presence of detrusor overactivity and Valsalva leak point pressure would predict surgical success. Subjects with urodynamic stress incontinence had a 2-fold greater odds of overall success when compared with the No urodynamic stress incontinence group, but this trend did not quite reach statistical significance (OR 2.26; 95% C.I. 0.99, 5.17). Odds of stress specific success did not differ by urodynamic stress incontinence status. Subjects with detrusor overactivity did not have significantly worse success rates. Stratifying by treatment group, there was no difference in mean Valsalva leak point pressure values between surgical successes and failures. We found a nearly statistically significant trend that women with urodynamic stress incontinence are twice as likely to have a successful overall outcome from surgical management of stress urinary incontinence as women without urodynamic stress incontinence. The level of Valsalva leak point pressure and the presence of detrusor overactivity do not predict the success outcomes after the Burch or autologous fascia sling procedures in women with pure or predominant stress urinary incontinence. The impact of urodynamic studies on surgical outcomes needs further investigation.

The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure

The objective of this study was to estimate the cure rate and to identify risk factors that predict failure of the tension-free vaginal tape (TVT) in women with stress urinary incontinence (SUI), a non-hypermobile urethra, and low maximum urethral closure pressure. Thirty-six women with SUI, a non-hypermobile urethra (straining urethral angle<or=35 degrees), and low maximum urethral closure pressure (MUCP<or=25 cm H2O) underwent a TVT. Cure was defined as resolution of subjective SUI symptoms and a negative cough stress test, which were measured after 4, 12, 18, and 24 months. Patient characteristics were compared and receiver-operator curves were used to identify risk factors for failure. The mean age was 71 years, and mean follow-up was 20.9 months. The overall cure rate was 78%. Risk factors for failure of the TVT were a straining urethral angle<or=20 degrees (cure rate 50%, odds ratio 7.7, p=0.02) and a MUCP<or=15 cm H2O (cure rate 60%, odds ratio 6.3, p=0.03). For women with both risk factors, the cure rate was only 17% (p<0.001). No other risk factors were identified. The TVT has moderate success (50-60%) for women with SUI and one risk factor (a straining urethral angle<or=20 degrees or a MVCP<or=15 cm H2O), but has poor success (17%) when both risk factors are present.

Perioperative complications and adverse events of the MONARC transobturator tape, compared with the tension-free vaginal tape

The objective of the study was to compare the incidence of perioperative complications of the MONARC transobturator tape with the tension-free vaginal tape in women undergoing surgical treatment for stress urinary incontinence. A retrospective review of all patients undergoing either a transobturator tape or tension-free vaginal tape between January 2003 and August 2005 was performed. The incidence of intraoperative and postoperative (6 weeks or less) complications was compared between groups. Two hundred five women underwent a transobturator tape and 213 women underwent a tension-free vaginal tape during the study period. Tension-free vaginal tape resulted in a significantly higher rate of bladder perforation than did transobturator tape (11 of 213 [5%] versus 0 of 205 [0%], P < .001). Postoperatively, subjects who received tension-free vaginal tape were significantly more likely to require urethrolysis for voiding dysfunction or urinary urgency (adjusted odds ratio 3.2 [95% confidence interval 1.2 to 10.1], P = .026) and more likely to use anticholinergic medications (adjusted odds ratio 2.1 [95% confidence interval 1.02 to 4.70], P = .046) than those who received a transobturator tape. Transobturator tape is associated with a lower rate of bladder injury, a decreased incidence of postoperative anticholinergic medication use, and fewer urethrolyses for postoperative voiding dysfunction or urinary urgency than tension-free vaginal tape.

The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence

A mailed questionnaire was sent to 970 consecutive women who underwent a tension-free vaginal tape (TVT) procedure between 1995 and 2001 at the Department of Obstetrics and Gynecology in Falun Hospital. Seven hundred and sixty (78.4%) women responded. The outcome was compared between women older than 75 years (n=113) and younger women, and between women with a body mass index (BMI) above 35 (n=61) and those who had normal weight. Mean follow-up was 5.7 years. Thirty-six elderly women and one of the obese women were deceased at the long-term follow-up. TVT was easy to perform and was a safe procedure for women in all groups. There was a sharp decrease in cure rate of any urinary incontinence problems among women aged 75 years or more (55.7%), as compared to those who were younger (79.7%). The cure rate moderately decreased from BMI groups 19-24 to 30-34. BMI > or =35 seemed to be the best explanatory cutoff level. The overall cure rate in women of normal weight was 81.2%, as compared to 52.1% in the very obese. The cure rate for urinary incontinence with tension-free vaginal tape in women above 75 years of age and in women with a BMI above 35 was acceptable, but lower as compared to the remaining study population.

Urogynaecology: Effect of tension‐free vaginal tape in women with a urodynamic diagnosis of idiopathic detrusor overactivity and stress incontinence

To determine the effect of tension-free vaginal tape (TVT) in women with idiopathic detrusor overactivity (DO) and urodynamic stress incontinence (USI) and to propose appropriate pre-operative counselling based on this information. Retrospective cohort study. Urogynaecology Unit, District General Hospital, Kent. Fifty-one women (from a total of 344 women undergoing TVT) with urodynamic evidence of both DO and USI who underwent TVT insertion between November 1999 and March 2003. Women with more than six-month follow up were assessed objectively with cystometry. Subjective results were assessed using structured interview and condition specific Kings Quality of Life Questionnaire. Objective resolution of DO and subjective absence of urge syndrome after TVT. Cure of USI was the secondary outcome measure analysed. The effect of drug therapy on residual urge symptoms was assessed. Objective cure of DO was demonstrated in 47% and subjective cure of urge symptoms in 63%. In women with persistent urge symptoms, the addition of anticholinergic medication resulted in resolution of urge incontinence in a further 22% of women. USI was objectively cured in 92%. More than 60% of women diagnosed urodynamically with DO and USI experience complete resolution of urge symptoms following TVT. Further symptom improvement can be achieved with additional anticholinergic medication.

Outcomes of Tension-Free Vaginal Tape in Women With Intrinsic Sphincter Deficiency With or Without Urethral Hypermobility

In Brief Objective: The objective of this study was to evaluate the outcomes of tension-free vaginal tape (TVT) for the treatment of female urodynamic stress incontinence (USI) resulting from intrinsic sphincter deficiency (ISD) in patients with and without urethral hypermobility. Methods: A 2-center cohort study of 175 consecutive women treated with TVT for USI with ISD over a 30-month period was performed. One hundred twenty-four (71%) women had coexisting urethral hypermobility and 51 (29%) had fixed urethrae. Concurrent surgical repairs were performed as required. Outcome data were collected at routine postoperative visits. Office and hospital records were reviewed to determine differences in patient characteristics, intraoperative findings, and surgical outcomes. The study was powered to detect a 20% difference in cure rates between the 2 groups. Results: Women with fixed urethrae were older than those with urethral hypermobility (72.3 versus 61.3 years, P < 0.0001) and were less likely to undergo concurrent anterior colporrhaphy (12% versus 37%, P = 0.0009). They were more likely to undergo concurrent posterior colporrhaphy (43% versus 20%, P = 0.0018). Cure rates among patients with fixed versus hypermobile urethrae were similar (83% and 86%, respectively, P = 0.61). Complication rates were similarly low in both groups (5.9% versus 5.6% for fixed and hypermobile urethrae, respectively). Postoperative voiding dysfunction occurred at similar rates in both groups (P = 0.96). Conclusion: TVT is a highly effective treatment among patients with USI resulting from ISD with comparable cure rates in patients with or without urethral hypermobility. Tension-free vaginal tape is an effective treatment for intrinsic sphincter deficiency, regardless of preoperative urethral mobility (Q-tip) status.

Outcome of the use of tension‐free vaginal tape in women with mixed urinary incontinence, previous failed surgery, or low valsalva pressure

To assess the safety and efficacy of the use of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with mixed incontinence, previous failed incontinence surgery or low valsalva leak point pressure (VLPP). Six hundred and fifty-eight women with SUI underwent the TVT procedure. These included women with mixed stress and urge incontinence (n=128), previous surgery for SUI (n=118), low VLPP (n=80), and those over 70 years old (n=68). The procedure was carried out under spinal anesthetic and operative and immediate postoperative data was collected for all women. Six-month follow-up data was available on 454 women, with the first 300 women completing a quality of life (QOL) questionnaire before and after surgery. The overall subjective cure rate at 6 months was 91%, with 8% of women reporting significant (>50%) improvement in their symptoms. Subgroups with a body mass index > 30, age > 70 years, coexisting instability, previous failed surgery, and low VLPP showed cure rates of 81-89%. QOL improvements for all groups were highly significant. Significant complications included voiding difficulties in 29 women (4.4%), retropubic hematomas in four (0.6%), and thromboembolic episodes in three (0.5%). The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.