Tension-free Midurethral Sling Research Articles

Efficacy of Pelvic Floor Ultrasound for Assessing Transobturator Tape Sling Procedure.

Complications after midurethral sling, which require a high degree of clinical suspicion for timely diagnosis, accurate evaluation, and proper intervention, are closely associated with surgical success or failure. This study aimed to evaluate the efficacy and complications of tension-free midurethral sling for stress urinary incontinence (SUI) using pelvic floor ultrasound. This retrospective study included 152 female patients with SUI admitted to the Jinhua Central Hospital between January 2020 and December 2021 who were selected. All patients underwent midurethral transobturator tape sling procedures and were divided into success, voiding dysfunction, overactive bladder, and failure groups according to postoperative efficacy and complications. The pelvic floor ultrasound examination was performed before and after the surgery. The posterior vesicourethral angle difference ( P < 0.01) was significantly lower after the surgery than before the surgery. The rate of bladder neck funneling ( P < 0.01) and the area of bladder neck funneling ( P < 0.01) were smaller after the surgery than before the surgery. The tape-longitudinal smooth muscle distance, the tape-symphysis pubis distance, the sling angle, and the tape-bladder neck/urethra increased successively in the voiding dysfunction, overactive bladder, success, and failure groups. Pelvic floor ultrasound can accurately evaluate the postoperative efficacy and complications of transobturator tape sling procedures for SUI and can reasonably guide the management of complications. Therefore, it is an effective imaging method for postoperative follow-up after tension-free midurethral tape suspension.

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis.

Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

Position of the Ibero-American Society of Neurourology and Urogynecology in relation to the use of synthetic suburethral meshes for the surgical treatment of female stress incontinence.

The aim of this paper is to stablish de position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) in relation to the use of suburethral meshes for the surgical treatment of female stress incontinence. Tension-free mid-urethral slings (MUS) have become the most popular procedure for the treatment of stress urinary incontinence (SUI). In July 2018, the British government announced a pause in the use of meshes for both pelvic organ prolapse (POP) and urinary incontinence (UI) treatment without differentiating whether the meshes were used for treating UI or POP. The decision was taken to stop their use until the publication of the updated UI and POP guidelines of the British National Health Service, which is available from April 2019. SINUG has reviewed the evidence and official position of different societies in relation to the safety and efficacy of MUS in the surgical treatment of incontinence differentiating them from meshes used to repair POP. Data from synthetic mesh manufacturers indicate that in 2010, 300 000 women underwent surgical procedures to repair POP and approximately 260 000 were operated on for SUI. According to these estimates, approximately more than 80% of the surgical techniques for UI treatment were performed transvaginally with meshes. Once reviewed evidence and position of different societies, the SINUG presents its vision in this communication, which is a summary of the document analysing the state of topic prepared by the society.

An Unusual Case of Acute Complete Urinary Incontinence 20 Days after Pelvic Floor Surgery and Tension-Free Vaginal Tape Insertion 20 Days after Pelvic Floor Surgery and Tension-Free Vaginal Tape Insertion

An 81-year-old woman presented herself with disturbing stress urinary incontinence and symptomatic pelvic organ prolapse. 30 years before she had had an abdominal hysterectomy and presumably a colposuspension. To repair the symptomatic pelvic floor disorder the patient needed an anterior and posterior colporrhaphy, vaginal repair of enterocele and anterior rectocele. Additionally, a tension-free midurethral sling (retropubic tension-free vaginal tape) was implanted because of stress urinary incontinence. Seven days postoperativelyshe resumed the prophylactic intake of acetylsalicylic acid. The first follow-up 14 days after surgery showed a correct position of the sling and the patient was continent. 20 days later an acute vaginal vault hematoma and complete urinary incontinence occurred.

Tension-free mid-urethral sling surgery for stress urinary incontinence: Complications and management

Tension-free mid-urethral sling surgery for stress urinary incontinence: Complications and management

The SIMS trial: adjustable anchored single-incision mini-slings versus standard tension-free midurethral slings in the surgical management of female stress urinary incontinence. A study protocol for a pragmatic, multicentre, non-inferiority randomised controlled trial

IntroductionSingle-incision mini-slings (SIMS) represent the third generation of midurethral slings. They have been developed with the aim of offering a true ambulatory procedure for treatment of female stress urinary incontinence...

A comparison of an objective and subjective test of stress urinary incontinence (SUI) and their acceptability to participants

Background SUI is a common and distressing condition affecting 3 million women in the UK. As part of the multicentre NIHR HTA funded SIMS study (Adjustable Anchored Single-Incision Mini-Slings Versus Standard TensionFree Mid-Urethral Slings in the Surgical Management Of Female Stress Urinary Incontinence; A Pragmatic Multicentre Non-Inferiority Randomised Controlled Trial) we are evaluating the acceptability and correlation of two patient tests of SUI -the objective 24hr pad test (PT) and the subjective home continence stress test (HCST).

Evaluating the use of real-time data collection using SMS texts in the SIMS study

Background A recent innovation in Patient Reported Outcomes (PROs) collection is the use of SMS texts. Results from a large randomised controlled trial (RCT) found this realtime data collection was both feasible and acceptable. As part of the multicentre NIHR HTA funded SIMS study (Adjustable Anchored Single-Incision Mini-Slings Versus Standard Tension-Free Mid-Urethral Slings in the Surgical Management Of Female Stress Urinary Incontinence; A Pragmatic Multicentre Non-Inferiority Randomised Controlled Trial), we evaluated responses to a post-surgery pain diary comparing PROs collected via texts and paper. The study raised several interesting data collection.

Dynamic maximum urethral closure pressures measured by high-resolution manometry increase markedly after sling surgery.

The premise of midurethral sling (MUS) surgery is to apply a tension-free vaginal tape in the midurethra that does not constrict the urethra at rest but stabilizes the urethra and prevents downward descent and opening of the urethra during stress maneuvers, but current technology has limitations in measuring urethral pressures during dynamic conditions. Our objective was to describe the change in maximum urethral closure pressures (MUCPs) after MUS surgery using an 8F high-resolution manometry (HRM) system that can measure urethral pressures during cough and strain maneuvers (ManoScan® ESO; Covidien) without migration or withdrawal limitations. We measured rest, cough, and strain MUCPs in 26 women before and after retropubic or transobturator MUS for stress urinary incontinence using the HRM system. The objective success rate after MUS was 92.3 % based on postoperative cough stress testing. Mean resting MUCPs measured by HRM did not change after surgery (59.3 before vs. 59.7 cm H2O after surgery; p = 1.0). Mean cough MUCPs measured by HRM increased from 36.9 to 100.7 cm H2O (p < 0.001), and strain MUCPs increased from 35.0 to 92.7 cm H2O (p < 0.001). Advanced HRM technology to measure MUCPs under cough and strain conditions without withdrawal techniques provides new insights into the continence mechanism after tension-free MUS: MUCPs do not change at rest but do increase significantly during cough and strain maneuvers.

Efficacy and quality of life after transobturator tension-free vaginal tape procedure for female stress urinary incontinence

Background: Nowadays, tension-free transobturator midurethral sling procedures have been gaining popularity in the surgical management of female stress urinary incontinence (SUI). However, quality of life (QoL) assessment following this new procedure is sparingly reported and requires further investigations for credentialing this intervention as a standard of care for women with SUI. Objective: To evaluate the QoL outcome using King’s Health Questionnaires (KHQ) scale following tension-free transobturator tape procedure. Materials and Methods: We evaluated 31 women with genuine SUI in a tertiary medical teaching hospital for QoL before and after the surgery using KHQ. The responses were analyzed for internal consistency, criterion validity, and improvements in various domains in relation to QoL, which could have been affected by their urinary symptoms. Results: Cronbach’s a statistics indicated good correlation between various items of the KHQ scale before and after surgery (0.88 vs 0.81). The criterion validity of the scale against Sandvik Short Format (SSF) indicated a good agreement between these two scales before intervention and during follow-up (Spearman’s rank correlation coefficient: 0.872 vs. 0.638). When it came to various domains of KHQ scale, there were significant improvements in all items (p < 0.0001) except General Health Perception (p = 0.69). There was no procedure-related morbidity. Conclusion: The results of this study indicate that KHQ can be effectively used for assessing QoL after TOT procedures. This procedure is also safe and effective for continence treatment.

The Formation of Abscesses in the Peritoneal Cavity and the Left Internal Obturator Muscle as the Complications of the Transobturator Tape Procedure

The synthetic, tension-free midurethral sling procedure using transobturator tape (TOT) was introduced in 2001. Since then, it has become a mainstream modality in patients with stress urinary incontinence. But, it has been reported to produce many complications such as mesh erosion, hematoma formation, and abscess. We experienced a case of abscess formation in the peritoneal cavity and left internal obturator muscle seven days after the TOT sling procedure, for which we performed a complete removal of mesh and a percutaneous drainage of the peritoneal abscess using 10.2-F drain-fix at the department of interventional radiology. To our knowledge, our case is one of the serious complications of the TOT procedure. Here, we report our case with a review of literatures.

Management of Complications After Tension-Free Midurethral Slings

Since their introduction in 1996, tension-free midurethral slings (MUS) have been proven to have long-term efficacy and safety. They are considered the gold standard treatment of female stress urinary incontinence, especially in cases that are associated with urethral hypermobility. However, they are not free of complications and, although rare, some of these complications can be challenging for both patients and physicians. Some complications occur intraoperatively, whereas others appear in the early or late postoperative period. There is less controversy in the diagnosis and treatment of complications such as vaginal extrusion or urinary system erosion, whereas de novo voiding problems are at best not completely understood. Voiding dysfunction after MUS placement may vary in a wide range from urinary frequency or urgency to retention and is usually attributed to the obstructive or irritative effect of the sling. However, present urodynamic criteria for the diagnosis of female infravesical obstruction are not satisfactory, and the best management policy for de novo voiding dysfunction remains controversial. In the majority of cases, the diagnosis of obstruction leading to a urethral release surgery depends on a combination of several clinical findings. The timing of urethral release surgery varies depending on the preferences of the surgeon, and the outcome of this surgery is not always predictable. The purpose of this review was to assess the diagnosis and management of the immediate, short-term, and long-term complications of MUS in light of the current literature in an attempt to determine the best management policy.

Evaluation of Endoscopic Laser Excision of Polypropylene Mesh/Sutures Following Anti-Incontinence Procedures

We reviewed our experience with and outcome of the largest series to our knowledge of patients who underwent endoscopic laser excision of eroded polypropylene mesh or sutures as a complication of previous anti-incontinence procedures. A total of 12 female patients underwent endoscopic laser excision of suture/mesh erosions at 1 center during a 10-year period. Primary outcome variables were the requirement of additional endoscopic or open surgery to remove mesh/sutures. Secondary outcome variables were persistence of urinary symptoms, postoperative complications, continence status and requirement of additional anti-incontinence procedures. The mean interval from previous surgery to erosion was 59 months (range 7 to 144) and the duration of presenting symptoms ranged from 3 to 84 months (mean 19). Ten patients underwent endoscopic excision of the mesh/suture with the holmium:YAG laser and 2 underwent excision with the thulium laser. Mean operative duration was 19 minutes (range 10 to 25) and followup was 65.5 months (range 6 to 134). Postoperatively 6 patients remain asymptomatic and 2 required a rectus fascial sling for recurrent stress urinary incontinence. Four patients underwent a second endoscopic excision due to minor persistence of erosion. Only 1 patient ultimately required open cystotomy to remove the eroded biomaterial. No intraoperative complications were recorded and all patients are currently asymptomatic. Endoscopic laser excision is an acceptable first line approach for the management of eroded biomaterials due to its high long-term success rate and minimally invasive nature.

Tension-free Vaginal Tape for the Treatment of Urodynamic Stress Incontinence: Efficacy and Adverse Effects at 10-Year Follow-Up

BackgroundOne of the most effective and popular current procedures for the surgical treatment of stress urinary incontinence (SUI) is tension-free midurethral slings. ObjectiveTo evaluate the outcomes of women with retropubic tension-free vaginal tape (TVT) for urodynamic stress incontinence (USI) after 10-yr follow-up. Design, setting, and participantsThis was a prospective observational study. Consecutive women with proven USI were treated with TVT. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded. InterventionStandard retropubic TVT. MeasurementsPatients underwent preoperative clinical and urodynamic evaluations. During follow-up examinations, women were assessed for subjective satisfaction and objective cure rates. Multivariable analyses were performed to investigate outcomes. Results and limitationsA total of 63 women were included. After 10 yr, 5 patients (8%) were lost or no longer evaluable. The 10-yr subjective, objective, and urodynamic cure rates were 89.7%, 93.1%, and 91.4%, respectively. These rates were stable across the whole study period (p>0.99). De novo overactive bladder was reported by 30.1% and 18.9% of patients at 3-mo and 10-yr follow-up, respectively (p for trend = 0.19). A total of 84.2% of women with detrusor overactivity received antimuscarinic drugs, but 43.8% were nonresponders 12 wk later. At multivariable analysis, maximum detrusor pressure during the filling phase >9cm H2O (hazard ratio [HR]: 16.2; p=0.01) and maximum detrusor pressure during the voiding phase ≤29cm H2O (HR: 8.0; p=0.01) were independent predictors for the recurrence of SUI, as well as obesity was for the recurrence of objective SUI (HR: 17.1; p=0.01) and of USI (HR: 8.9; p=0.02), respectively. Intraoperatively, bladder perforation occurred in two cases; no severe bleeding or other complications occurred. ConclusionsThe 10-yr results of this study seem to demonstrate that TVT is a highly effective option for the treatment of female SUI, recording a very high cure rate with low complications after a 10-yr follow-up.

Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse: Tension free slings with colporrhaphy, or Prolift with the tension free midurethral sling?

Objective Comparison of procedures in patients with concomitant stress urinary incontinence (SUI) and pelvic organ prolapse (POP) was performed. Tension free vaginal tape (TVT) or transobturator tape (TOT) with colporrhaphy was compared with fixed mesh (Prolift™) applied with a tension free suburethral sling. Study design A total of 76 women with both SUI and POP were evaluated. TVT or TOT with colporrhaphy was performed in 39 patients and Prolift™ with the midurethral sling in 37 patients. Anatomy, symptoms and quality of life (QOL) were evaluated prior to, and at 1, 6 and 12 months after surgery. Results Continence was achieved in both groups equally ( p = 0.57). The better anatomic outcome regarding the correction of POP was in the Prolift™ group but with a higher rate of additional procedures and complications. QOL was better in patients with grade III–IV POP corrected with Prolift™ ( p = 0.05) and equal in both groups with grade I–II POP during the follow-up. Impairment of sexual life was present in both groups before surgery. After surgery, there was no improvement in sexual life regardless of correction of both anatomy and incontinence. Conclusion Both procedures are effective and safe. TVT or TOT performed with colporrhaphy looks a better primary choice for grade II POP and SUI. Results for grade III–IV POP and SUI are better with the Prolift™ with the sling. Sexual life could not be improved effectively with these types of surgery.

Bilateral Recurrent Thigh Abscesses for Five Years after a Transobturator Tape Implantation for Stress Urinary Incontinence

The synthetic, tension-free midurethral sling procedure using transobturator tape (TOT) was introduced in 2001 and has become the most widely used procedure for the treatment of female urinary incontinence worldwide. However, infectious complications associated with erosions have occasionally been reported because of a foreign body reaction to the polypropylene mesh. We observed a case of a bilateral recurrent thigh abscess manifesting 5 years after a TOT sling procedure. The patient had recurrent thigh abscesses with repeated incisions and drainages in the past 1 year. Five months earlier, she had undergone a procedure to remove the eroded suburethral mesh, but incompletely. The right thigh abscess recurred, and ultimately the residual mesh was completely excised with abscess drainage. Complete mesh removal is very important to prevent abscess recurrence, and it is necessary for any urologist treating women who have undergone the TOT procedure to be aware of the possibility of abscesses occurring for a long time after the operation.

Risk of tape‐related complications after TVT is at least 4%

Neurourology and UrodynamicsVolume 29, Issue 1 p. 40-41 Letter to the EditorFree Access Risk of tape-related complications after TVT is at least 4%† Robert Jones, Robert Jones Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorPaul Abrams, Paul Abrams Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorPaul Hilton, Paul Hilton Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorKaren Ward, Karen Ward Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorMarcus Drake, Corresponding Author Marcus Drake [email protected] Southmead Hospital, Bristol Avon, United KingdomSouthmead Hospital, Bristol, Avon BS10 5NB, United Kingdom.Search for more papers by this author Robert Jones, Robert Jones Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorPaul Abrams, Paul Abrams Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorPaul Hilton, Paul Hilton Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorKaren Ward, Karen Ward Southmead Hospital, Bristol Avon, United KingdomSearch for more papers by this authorMarcus Drake, Corresponding Author Marcus Drake [email protected] Southmead Hospital, Bristol Avon, United KingdomSouthmead Hospital, Bristol, Avon BS10 5NB, United Kingdom.Search for more papers by this author First published: 18 December 2009 https://doi.org/10.1002/nau.20851Citations: 34 † Christopher Chapple led the review process. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1 Ward K, Hilton P. Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ 2002; 325: 67. 2 Novara G, Galfano A, Boscolo-Berto R, et al. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: A systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol 2008; 53: 288– 308. 3 Morton HC, Hilton P. Urethral injury associated with minimally invasive mid-urethral sling procedures for the treatment of stress urinary incontinence: A case series and systematic literature search. BJOG 2009; 116: 1120– 6. 4 Ward KL, Hilton P. Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 2008; 115: 226– 33. Citing Literature Volume29, Issue1January 2010Pages 40-41 ReferencesRelatedInformation

Transobturator tapes are preferable over transvaginal tapes for the management of female stress urinary incontinence: For

Tension-free midurethral slings have proven to have low morbidity and high success rates in the management of female stress urinary incontinence. Among midurethal slings, the transobtuator tapes has comparable success and satisfaction rates as the transvaginal tapes but with reduced risk of intra-operative bladder injury, shorter operating time and quicker return to activities. Thus, the transobturator tapes may be recommended as the primary choice for the treatment of female stress urinary incontinence.

Surgical intervention for stress urinary incontinence: comparison of midurethral sling procedures.

The synthetic, tension-free midurethral sling was introduced in the 1990s as a surgical treatment for women with stress urinary incontinence (SUI). Several similar products are now available. The authors generated data comparing clinical outcomes of two midurethral sling procedures. To compare clinical outcomes of two midurethral sling procedures currently used for the treatment of women with SUI: Gynecare Tension-free Vaginal Tape (TVT; Ethicon Women's Health & Urology, Somerville, NJ) and Uretex Self-Anchoring Urethral Support System (CR Bard Inc, Covington, Ga). A nonrandomized, prospective study was conducted at a urogynecology practice with women who had preoperative urodynamically proven SUI. The study consisted of two phases: 100 consecutive cases using the TVT midurethral sling, then 100 consecutive cases using the Uretex midurethral sling. Symptom improvement was evaluated at 12-month postoperative follow-up by measuring rates of prolonged intermittent self-catheterization, urinary tract infection, urinary retention requiring urethrolysis, and new-onset urge incontinence. The TVT and Uretex groups were similar with respect to age, parity, and incidence of prior anti-incontinence surgery. There was no significant difference in outcomes measured between the two groups in symptom improvement at 12-month follow-up. The TVT and Uretex midurethral slings demonstrate similar short-term improvement and complication rates in a nonrandomized population of women with SUI.

Novel Repair of Tension-free Midurethral Sling Erosion into the Urethra

Severe urinary tract injury is a relatively uncommon occurrence after the placement of a tension-free vaginal tape sling. Bladder perforation is the most common urinary tract injury, but bladder drainage for a few days is usually the only intervention that is required. Urethral erosions of synthetic sling tapes are much rarer, but can result in more significant sequelae such as voiding dysfunction or fistula formation. A 50-year-old woman had an erosion of a synthetic, tension-free midurethral sling through the urethra. She underwent resection of the sling with closure of the urethral defect. The internal urethral sphincter was used during the primary repair to cover the defect because of periurethral scarring and fibrosis. This technique may reduce the risk of subsequent fistula formation, and may be a less invasive alternative to the use of a Martius interposition flap.