Tape Surgery Research Articles

The outcomes of transobturator tape intervention in the treatment of stress urinary incontinence: Two years' follow-up.

Objective:To evaluate the clinical outcomes and the effects on quality of life of transobturator tape surgery during a 2-year follow-up period in our clinics.Methods:Eighty-seven patients with stress or mixed urinary incontinence who underwent transobturator tape surgery were included in the study conducted in Istanbul. Taksim. Training. and Research Hospital Gynecology and Obstetrics Clinic, between 2011 and 2013. The patients’ demographic features, incontinence questionnaires, quality of life scores [Incontinence Impact Questionnaire (IIQ-7) and urinary distress inventories (UDI-6)], examination findings, urodynamic results, stress tests, Q tip tests, number of daily pads, ultrasonography, surgery, and cystoscopy results were recorded. Patients were evaluated 23-27 months (mean: 25.40±1.31 months) after their discharge in terms of symptoms, quality of life scores, urodynamic findings, complications, and stress test.Results:Sixty-three (72.4%) patients had stress incontinence and 24 (27.6%) patients had mixed urinary incontinence. No perioperative complications were observed in our study. After a follow-up period of two years, a significant improvement was detected in the IIQ-7 and UDI-6 questionnaires when compared with the preoperative period. Moreover, the objective cure rate was found as 88.5% (n=77). De novo urge incontinence was obtained in 5.7% (n=5) of patients and was treated with anticholinergics. Perineal pain was present in 3 (3.44%) patients and was treated with analgesics and cold packs. In 2 (2.29%) patients, vaginal mesh erosion was detected and full recovery was achieved with an excision. Urinary retention and bladder perforation was not seen in any patients.Conclusion:Our study revealed a high objective cure rate, and an improvement in symptoms and quality of life with the transobturator tape operation.

Evaluation of the Effect of Transobturator Tape Operation Used in Urinary Incontinence Therapy on Sexual Function

Evaluation of the Effect of Transobturator Tape Operation Used in Urinary Incontinence Therapy on Sexual Function

Patient goal achievement 2 years after a tension-free vaginal tape operation.

The primary aim of this study was to investigate long-term patient-reported goals after a tension-free vaginal tape (TVT) operation for stress urinary incontinence (SUI). In this prospective study involving 67 women, patients completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) preoperatively and stated three goals for the operation. Postoperatively, a visual analog scale (VAS) ranging from zero (none) to ten (worst) estimated the extent to which goals were achieved. Goals were divided into five groups: symptoms, quality of life (QoL) (physical), QoL (emotional), sexual function, avoidance, and others. Short-term achievement of goal was estimated after 3months and long-term achievement of goals after a mean of 28.2months. A total of 201 goals were stated, most of which (38%) were in the group concerning QoL in physical domains. Mean VAS score for all goals was 9.1 after 3months and 8.5 at long-term follow-up. ICIQ-UI SF preoperatively was mean 14.9; 3months' postoperatively mean 1.4; and at long-term 3.8. The small rise in ICIQ-UI SF at long-term follow-up was statistically insignificant and due to urge urinary incontinence (UUI). Our study showed that patients achieved their goals to a high degree and maintained them at long-term follow-up. Most goals concerned QoL in physical domains. Although a proportion of women experienced episodes of UUI at the long-term follow-up, VAS score was not significantly changed.

The Effect of Stress Incontinence Operations on Sexual Functions: Laparoscopic Burch versus Transvaginal Tape-O.

Aim:Stress urinary incontinence (SUI) has some negative emotional and physical effects on sexual functions. In this study, we aimed to question the effects of surgical treatment of stress incontinence on sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) form.Materials and Methods:A total of 77 sexually active women who were surgically treated for SUI between 2014 and 2015 at a university hospital. Tension-free transvaginal tape (TVT-O) operation and the laparoscopic Burch procedure were performed on 42 and 35 patients, respectively. Patients with isolated stress incontinence were included in this study. All patients enrolled were invited to fill out the PISQ-12 questionnaire before surgery and 6 months after surgery.Results:The mean total postoperative PISQ-12 score in both TVT-O and Burch groups was significantly increased compared to the preoperative period (P < 0.001 and P < 0.001, respectively). When the PISQ-12 scores were evaluated according to the subgroups, physical and partner-dependent scores significantly increased in the postoperative period compared to the preoperative period in the TVT-O group (P < 0.001 and P = 0.004, respectively).Conclusions:Rate of the surgery success for SUI is positively correlated with the improvement of sexual functions. Minimally invasive methods in SUI surgery has been progressively increasing day-by-day. The lesser invasive approaches seem to replace the more invasive approaches in the near future.

Evaluation of The Transobturator Tape Operation Results and Complications in The Patient with Stress Incontinence

Evaluation of The Transobturator Tape Operation Results and Complications in The Patient with Stress Incontinence

Long-term Follow-up of Sexual Function in Women Before and After Tension-Free Vaginal Tape Operation for Stress Urinary Incontinence

(Abstracted from Int Urogynecol J 2016;27:1571–1576) A number of studies have investigated the effect of incontinence surgery on sexual function in women. Results have been conflicting; some studies have reported improvement, some deterioration, and others no difference.

Trans-Obturator Tape Operation Using MONARC Technique (Outside-In Technique) --- Revisited Objective And Subjective Assessment

Objective: This study was undertaken to describe and evaluate the outcome of trans-obturator tape (TOT) operation using Outside-In technique without cystoscopy. This procedure was carried out either solely or as a part of pelvic reconstructive surgery. Design: Retrospective cohort study with follow up objective and subjective assessment. Population: 84 women were presented with urodynamic stress incontinence at North Cumbria NHS Trust. They were treated with transoturator tape operation using outside-in technique between the years 2007 and 2008. Method: Eighty-four women underwent trans-obturator tape operation (outside-in technique) without cystoscopy. Diagnosis of stress urinary incontinence (SUI) was made by uro-dynamic studies. They were all operated only by a single surgeon. The mean length of follow-up was 6 months. Operative complications were recorded. The anatomic integrity of urethra, the anterior vaginal wall was objectively assessed at follow up visit. Subjective assessment was made during patient consultation. Objective failure was defined as persistence of urodynamic stress urinary incontinence. Subjectively, failure was defined mainly as persistence of stress incontinence symptoms. Other related symptoms are noted like voiding difficulties and sexual dysfunction. Results: In the study data eighty four women underwent a TOT operation. The mean age was 50 years (38-63). Pre-operatively, of those 84 patients, SUI was diagnosed in 62 patients while mixed urinary symptoms were present in 22 patients. Transobturator tape operation was carried out using MONARC subfacial hammock system in all women. Additional pelvic surgical procedures were performed according to the presence of other pelvic defects. No intraoperative complications were recorded. The estimated blood loss was 125 mL (range, 50-200 mL). None of the patient had suspected bladder or urethral injury intraoperatively. Transient urinary retention was observed in 8% (n= 7) of women in immediate postoperative period. Three women developed urinary tract infection in immediate postoperative period and in one woman urethral pus was noted which resolved with the help of oral antibiotics. Postoperative objective assessment was made with speculum examination and stress provocation tests like cough and valsalva manoeuvres. There was no stress incontinence on stress provocation tests. Two women developed de novo urge incontinence that was treated with anticholinergics. Two complained of worsening urge incontinence symptoms and none of the women having concurrent urge incontinence symptoms showed any improvement in their urge incontinence symptoms. The overall subjective success rate was 92% (n= 77). Six women judged themselves to be improved in terms of stress incontinence but were still wearing protection, although less, to avoid any urinary leakage. One woman gave history of prickling sensation in the vagina after the procedure at her follow-up visits, from 6 weeks to 9 months although she was reassured and that prickling sensation resolved at 9 month follow-up. Conclusion: Transobturator tape operation (outside-in technique) without cystoscopy seems an effective and safe treatment of urodynamic stress incontinence. It has a good subjective and objective outcome. A large study may be required to confirm the results.

Evaluation of postoperative sexual function in patients after trans-obturator-tape operation

Introduction: In this study, we aimed to evaluate postoperative se-xual function of patients, who had undergone colporraphy anterior and transobturator tape operation due to cystocele and stres urinary incontinence. Materials and Methods: In our study, 52 patients with cystocele and stress urinary incontinence that were admitted to Dicle University, School of Medicine, Department of Obstetrics and Gynecology between January 2009 and January 2014, were included in the study. Patients with previous hysterectomy, patients who had rectocele repair during operation, patients in menopause were excluded from the study. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 before and after under going surgery. Results: Mean age of the patients in our study was 42.04 ± 7.50, average body mass index of the patients was 30.1 ± 3.7 kg/m2. Average follow-up time was 31.5 ± 11.3 months. 22 (42.3%) patients did not completely recovery the postoperative complaints. 2 (3.8%) patients had increased postoperative complaints. The positive correlation between postoperative complaints with dyspareunia was observed (r= 0.355 **p: 0.010). 5 (9.6%) patients developed postoperative complications. These complications, urinary comfortable inability in 2 (%3.8) patients, mesh erosion in 1(%1.9) patient, developed de novo urinary incontinence in 2 (%1.9) patients. The total result according to Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 was observed significant improvement in sexual function (p= 0.000). Conclusion: Urinary incontinence negatively affects the sexual life of women. We observed improvement in sexual function of women that had went transobturator tape operation for urinary incontinence.

Fulfilment of patient goals after tension-free vaginal tape operation for stress urinary incontinence.

The aim of this study was to investigate patient-reported goals after a tension-free vaginal tape operation for stress urinary incontinence and the correlation with postoperative incontinence. A prospective study involving 70 women was carried out. Preoperatively, patients completed the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and stated three goals for the operation. A telephone interview was performed 3months postoperatively. A Visual Analogue Scale (VAS) score from zero to ten estimated the extent to which goals were achieved. Goals were divided into five groups: 1, symptoms; 2, quality of life (physical); 3, quality of life (emotional); 4, sexual function; 5, avoidance. ICIQ-UI SF preoperative mean was 14.9 and postoperative mean was 1.5 (p < 0.05). A total of 210 goals were stated. The majority of the goals (38%) were in group 2 concerning quality of life in the physical domains. Mean VAS score for all goals was 9.1 (SD 2). Thirty-seven patients (53%) fulfilled all their goals. Twenty-one patients (30%) did not have a VAS score of 10, although continent with an ICIQ-UI SF score of zero. Reasons for not achieving a full VAS score were that some still used pads out of fear (n = 10), that their mental focus was still on incontinence (n = 7) or that they had not yet tried some of the physical aims (n = 7). Most patients achieved their goals. The majority of the goals concerned quality of life in the physical domains.

Long-term follow-up of sexual function in women before and after tension-free vaginal tape operation for stress urinary incontinence.

This prospective study investigates sexual function in women after a tension-free vaginal tape (TVT) operation and compares short-term and long-term effects. Sixty-three women had a TVT operation performed at Aalborg University Hospital, Department of Gynecology and Obstetrics, between November 2008 and June 2010. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 6months postoperatively, and at the long-term follow-up (mean 4years and 9months). Forty-four women completed the two questionnaires all three times. Preoperatively, mean PISQ-12 was 33.8 [95% confidence interval (CI) 28.9-38.6] and the ICIQ-UI SF was 15.2 (14.4-16.0). Postoperatively the PISQ-12 increased significantly and the ICIQ-UI-SF decreased significantly, to 36.7 (31.5-41.9) and 2.5 (1.3-3.8), respectively, at the 6-months follow-up and 35.8 (33.6-38.1) and 4.9 (3.4-6.3), respectively, at the long-term follow-up. The greates improvement was in the physical domain of the PISQ-12. Women experienced less negative emotional reactions during intercourse, less coital incontinence, and less fear of being incontinent during intercourse after the TVT operation. This study shows that a woman's sex life does not deteriorate after a TVT operation, that their sexual function improves somewhat, and that results are sustained over time.

Delayed sigmoid colon perforation and enterocutaneous fistula due to tension free transvaginal tape operation for stress urinary incontinence.

A 56-year-old female patient presented with sustained sigmoid colon perforation at the time of a tension-free vaginal tape (TVT) procedure and subsequently developed enterocutaneous fistula and subcutaneous abscess. She came to our emergency department complaining of left lower abdominal tenderness and swelling for 2 weeks previously. Her right thigh also was tender and swollen. A foreign body in sigmoid colon and subcutaneous abscess were found on computed tomography scan. We diagnosed the perforation of sigmoid colon and enterocutaneous fistula by TVT mesh. We performed laparoscopic excision of the mesh in sigmoid colon. We performed transobturator tape surgery for recurrence of stress urinary incontinence after 6 months.

Comparative Study between Trans Obturator Vaginal Tape Operation and Burch Colposuspension in Treatment of Female Stress Urinary Incontinence

Comparative Study between Trans Obturator Vaginal Tape Operation and Burch Colposuspension in Treatment of Female Stress Urinary Incontinence

Sexual function in women before and after tension-free vaginal tape operation for stress urinary incontinence.

To evaluate sexual function in women before and after tension-free vaginal tape operation for stress urinary incontinence. Prospective study. Aalborg University Hospital, Department of Gynecology and Obstetrics between November 2008 and June 2010. Sixty-three women who had a tension-free vaginal tape operation performed. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 6 months postoperatively. Differences in PISQ-12 measures 6 months after the tension-free vaginal tape operation. Twelve women were excluded because of non-completed questionnaires. Preoperatively the PISQ-12 score was 33.7 and postoperatively 36.7, giving a significant difference of 3.0 (p < 0.05). Forty women (78%) scored higher postoperatively, five (10%) scored the same and six (12%) reported lower scores postoperatively. Only PISQ-12 questions in the physical domain were significantly improved. These values were elevated close to the maximum score. Preoperatively 18 women (35%) experienced coital incontinence always, often or sometimes. Postoperatively this was only the case in two women. Most women experience an improvement in sexual life after a tension-free vaginal tape procedure mainly because of absence of incontinence during sexual activity or absence of fear of incontinence during sexual activity.

Coronary vasospasm caused by local infiltration of epinephrine after spinal anesthesia.

Coronary vasospasm caused by local infiltration of epinephrine after spinal anesthesia.

Effect of Preoperative Flow Rate on Postoperative Retention and Voiding Difficulty After Transobturator Tape Operation

PurposeControversy exists over the preoperative risk factors for postoperative urinary retention after the midurethral sling procedure for stress urinary incontinence (SUI). We intended to analyze the effect of preoperative flow rate on postoperative urinary retention after the transobturator tape (TOT) operation.Materials and MethodsA total of 322 patients who underwent TOT from June 2006 to May 2012 were included in this retrospective study. All patients were preoperatively investigated for urinary symptoms and underwent preoperative urodynamic studies including urine flow rate. Postoperative urinary retention, voiding difficulty, and uroflowmetry were checked. Urinary retention was defined as the need for additional catheterization longer than 1 day. Patients were divided by preoperative peak flow rate (Qmax) of 15 mL/s (low Qmax group and normal Qmax group).ResultsThere were 3 cases of postoperative urinary retention (0.9%) and 52 cases of voiding difficulty (16.1%). The low Qmax group included 40 patients (12.4%) and the normal Qmax group included 282 patients (87.5%). Between the two groups, there were no significant differences in age, previous pelvic surgery history, or past medical history. The low Qmax group had higher scores for voided volume and detrusor pressure at Qmax. However, there was no significant difference in postoperative voiding difficulty between the two groups. Furthermore, three patients who experienced postoperative retention showed high flow rates preoperatively.ConclusionsOur results suggest that voiding difficulty in the group with low preoperative flow was tolerable and the treatment success rate was comparable to that in patients in the normal flow group. According to our analysis, patients with a low flow rate preoperatively can be safely treated with TOT for SUI.

Seventeen years’ follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence

The minimally invasive tension-free vaginal tape (TVT) operation has become the "gold standard" of incontinence surgery. The aim of the present study was to evaluate the long-term effect of the tape material and to assess the continence status 17 years after surgery A cohort of 90 women operated upon with the TVT procedure at three Nordic centers has been prospectively followed for 17 years. All of the women alive according to national registries were contacted and invited to visit the clinics for evaluation. Pelvic examination was performed to reveal any adverse effects of the tape material. Objective and subjective continence status were assessed by a cough stress test and the patients' global impression of improvement as well as by condition-specific quality of life questionnaires. Seventy-eight percent of the potentially assessable women were evaluated either by a clinic visit or by a telephone interview. One case of a minimal, symptom-free tape extrusion was seen. No other tape complications occurred. Over 90 % of the women were objectively continent. Eighty-seven per cent were subjectively cured or significantly improved. The TVT operation is durable for 17 years, with a high satisfaction rate and no serious long-term tape-induced adverse effects.

Recurrent obturator abscess with spontaneous expulsion of the mesh after transobturator tape operation

The transobturator tape operation has been the most popular method of SUI surgery worldwide owing to its low complication rate and high success rate. However, erosions and abscesses secondary to transobturator tape have been observed. Here we report a 36-year-old woman referred to our unit with fever, persistent swelling in the left groin, difficulty in walking, and a tape that came through the vagina, 4 years after the transobturator tape operation. She had a history of ischiorectal abscess and rectovaginal fistula. A recurrent obturator abscess with fistula formation and spontaneous expulsion of the mesh was diagnosed. The patient underwent antibiotic therapy, incision through the fistula tract, drainage of the abscess, and removal of the necrotic material. Patients should be informed about risks of erosion and infection and that pain and foul smelling vaginal discharge might be the first signs of severe infectious morbidities after transobturator tape operation.

Follow‐up of the tension‐free vaginal tape operation in everyday practice

A retrospective study was performed on clinical follow-up after tension-free vaginal tape (TVT) operations for urinary stress incontinence in our department. Uncomplicated cases of TVT were followed with a telephone interview performed by a specialized nurse three months postoperatively and complex cases with a clinical examination after three months. During one year, 85/117 (73%) were followed by telephone interview and 32/117 (27%) clinically. Of those with a scheduled telephone interview, 73 (86%) were satisfied and without complications, while 12 had a clinical consultation either before or after the interview. Two patients with a scheduled telephone interview developed voiding dysfunction and contacted the operating department. Selecting uncomplicated cases for telephone interview after TVT operation is feasible for the majority of cases.

Are Expensive Materials Really Necessary to Perform Transobturator Tape Operations?

Secondary injuries especially extremity fractures may be seen concurrently with traumatic brain injury (TBI). Peripheral nerve damages may accompany to these fractures and may be missed out, especially in acute stage. In this case report; damage of radial, ulnar and median nerves which was developed secondarily to distal humerus fracture that could not be detected in acute stage, in a patient who had motor vehicle accident (MVA). 29-year-old male patient was admitted with weakness in the right upper extremity. 9 months ago, he had traumatic brain injury because of MVA, and fracture of distal humerus was detected in follow-ups. Upon the suspect of the peripheral nerve injury, the diagnosis was confirmed with ENMG. The patient responded well to the rehabilitation program treatment. In a TBI patient, it must be kept in mind that there might be a secondary trauma and therefore peripheral nerve lesions may accompany to TBI.

Randomized trial of graft materials in transobturator tape operation: biological versus synthetic

To compare the outcome of outside-in biological and synthetic transobturator tape (TOT) operation, including subjective and objective success rates, urodynamics, and quality of life. One hundred patients suffering from clinical and/or urodynamic stress urinary incontinence (SUI) were randomized into biological material TOT (PELVILACE® TO) or synthetic material TOT (ALIGN®TO Urethral Support System) groups. Preoperative and at 1 year postoperative urogynecological symptom assessment, 1-h pad test, 4-day bladder diary, stress test, Q-tip test, and urodynamics were performed. For the evaluation of quality of life, the King's Health Questionnaire, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, and Prolapse Quality of Life were used. There was no significant difference between the two groups regarding objective and subjective cure rates and quality of life. At 1-year follow-up, the subjective cure rate was 68 % in the biological material TOT and 70 % in the synthetic material TOT group. No perioperative complications developed. Groin pain developed in 2 patients in the biological TOT group and 1 patient had dehiscence in the periurethral incision, which healed with local estrogen. Two patients had transient urinary retention in the synthetic TOT group, 1 patient developed groin pain, and 1 patient had mesh erosion observed at the 1-year follow-up. Transobturator tape with biological material in the management of SUI has a rate of success and patient satisfaction similar to those of synthetic material at 1-year follow-up. Studies with longer follow-up and larger cohorts are necessary to evaluate possible autolysis and degradation of biological slings and a possible reduction in efficacy over time.