Tension-free Obturator Tape Research Articles

Role of Preoperative and Postoperative Endovaginal Ultrasound and 24 h Pad Test in Evaluation of Efficacy of Various Treatment Modalities for Stress Urinary Incontinence

ABSTRACT Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women. Materials and Methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and 6 months postoperatively for levator hiatus (LH), pubovisceral thickness, urethral length, and bladder neck (BN) position. A 24 h pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%). Results: The mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m2, respectively. All 40 (100%) patients had SUI with a mean duration of symptoms being 4.04 years. On 24 h pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%) with mean preoperative 24 h pad test being 36.69 g which significantly reduced to 9.79 g postoperatively (P = 0.001). There was significant change in LH and pubovisceral thickness with treatment of SUI. Overall urethral length increased but there was significant decrease in urethral length on Valsalva after the treatment (0.40 cm vs. 0.28 cm, P = 0.04) and significant reduction in BN descent after Valsalva after treatment (0.41 cm vs. 0.27 cm, P = 0.001). Conclusion: Endovaginal ultrasound and 24 h pad test are the useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.

Role of Incontinence Severity Index in Evaluating Severity and Impact of Treatment Of Stress Urinary Incontinence.

Background:Stress urinary incontinence (SUI) is a common ailment in affecting quality of life. This study was performed to see role of incontinence severity index (ISI) in evaluating severity of SUI and to see the impact of treatment of SUI.Materials and Methods:A total of 40 women with the diagnosis of SUI on history and clinical examination were enrolled. ISI was calculated on all the women before treatment. All women were treated with either conservative treatment (pelvic floor exercises, life style modification, and duloxetine therapy) (4, 10%) or Burch's colposuspension (18, 45%) or tension-free obturator tape (18, 45%) as per clinical situation after discussion with patients. ISI was again calculated 6 months after treatment.Results:Mean age, parity, body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m2, respectively. All 40 (100%) patients had SUI with the mean duration of symptoms being 4.04 years. A total of 11 (27.5%) had moderate SUI (ISI 3–6), while 24 (60%) had severe SUI (ISI 8–9), while 5 (12.5%) had very severe SUI (ISI 12). Range of pretreatment ISI was 3–12 with mean being 8.8 ± 3.2. Posttreatment ISI reduced significantly with range of 1–4 and mean of 1.3 ± 0.4 (P < 0.001). The reduction was significant for all the groups, but there was no significant difference in efficacy of three treatment groups. Statistical analysis was done using SPSS IBM Version 2-1-0 using Chi-square test, Fisher's Extract test, and ANOVA test as appropriate.Conclusion:ISI is a useful modality to evaluate the severity of SUI and to see the impact of treatment modalities on SUI.

Complications of Mid-Urethral Tape Insertion

Background: Urinary stress incontinence is a health condition affecting millions of women globally with an incidence reaching 35%. The initial management is usually of conservative nature in the form of pelvic floor muscle training. If this fails then surgical management is offered. There are different methods of managing urinary stress incontinence like mid-urethral tape (MUT) insertion, colposuspension or the use of urethral bulking agents. In our unit, MUT insertion has been the conventional method of surgical management. Methods: The data were obtained from retrospective auditing of our practice in our Trust that was conducted on three different phases over 4 years (2011 to 2015). The source of information was the database and clinical notes. Results: A total of 221 patients underwent MUT insertion. Thirty-five procedures were performed by urologists and 185 by gynecologists. Twenty-three surgeries were performed by gynecologic trainees under senior supervision. All the MUT insertions performed by urologists were performed by consultants. Fifty patients (22.6%) experienced urinary retention, 18 had to use clean intermittent catheterization (CISC) (8%), and 41 patients (13%) developed symptoms of over-active bladder. There have been four bladder perforations (1.8%) all associated with tension-free vaginal tape (TVT) procedures and two cases of tape erosions (1%). Four patients (5%) complained of groin pain post-operatively; all of them had undergone tension-free obturator tape (TVT-O) procedure. There have been no buttonhole injuries, pelvic hematomata, or bleeding complications. In addition to that there have been no post-operative infections. Conclusions: Our complication rates have been concomitant with those described in literature. A surgical database proves helpful not only in auditing surgical effectiveness but also in comparing the surgical managements between different surgeons and departments. J Clin Gynecol Obstet. 2019;8(2):44-47 doi: https://doi.org/10.14740/jcgo544

Tension-free Vaginal Tape vs Tension-free Obturator Tape for Treatment of Genuine Stress Urinary Incontinence: A 5-year Follow-up

ABSTRACT Objective To compare the effectiveness of tension-free vaginal tape (TVT) and tension-free obturator tape (TOT) in treatment of genuine stress urinary incontinence and study the related complications. Materials and methods About 150 cases with complaints of stress urinary incontinence were taken during 5-year period, and they were confirmed urodynamically. Exclusion criteria included patients with diabetes mellitus, neurological disorders, other forms of incontinence, uterovaginal prolapse, urinary tract infection, and pregnancy. Out of 150 cases, 70 underwent TVT procedure and 80 were taken up for TOT. The outcome was studied at the end of 5 years. Results The cure rate in the TOT group was 94%, which was slightly higher than the TVT group, which came out to be 90%. The failure rate in the TVT group was 1.1%, but no failure was encountered in the TOT group. However, the improvement rates were similar in each group. Comparing the complications in each group, the rate of bladder perforation and postoperative retention of urine was much higher in the TVT group. Postoperative voiding difficulties were also noticeably less in TOT group compared with TVT group. However, none of the cases in either group had de novo urgency. Conclusion Both the procedures are a safe and effective method of curing stress incontinence; however, owing to slightly higher improvement rates and lower complications rate, TOT should be preferred over TVT. How to cite this article Bhadana P, Mittal P, Bachani S. Tension-free Vaginal Tape vs Tension-free Obturator Tape for Treatment of Genuine Stress Urinary Incontinence: A 5-year Follow-up. J South Asian Feder Obst Gynae 2017;9(2):89-93.

The Suburethral Sling Transobturator Approach for Stress Urinary Incontinence Treatment in Women in the Maternity and Neonatology Center of Tunis (WTSC)

The authors, through a descriptive retrospective study have evaluated the results of surgical treatment, by Tension-Free Obturator tape (TOT) technique, of urinary incontinence in the first 68 patients operated in the Department “C” of Obstetrics and Gynecology of the Maternity and Neonatology Centre of Tunis (WTSC). The average age in those patients was 55.14 ± 8.47 years with extremes of 40 and 82 years. The majority of the patients (72%) were under the age of 60 years. In sixty-one patients (89%), no urine leak has been detected and they were healed. In three patients (4%) there was improvement with partial recovery. Three other (4%) did not notice any improvement after the surgery. No case of dysuria or rejection of the strip has been reported. It was concluded that the declared satisfaction rate is 93%.

Expression and significance of TIMP-3, PACAP and VIP in vaginal wall tissues of patients with stress urinary incontinence

The objective of the present study was to investigate whether tissue inhibitor of metalloproteinase-3 (TIMP-3), pituitary adenylate cyclase-activating polypeptide (PACAP), and vasoactive intestinal peptide (VIP) participate in the occurrence of female stress urinary incontinence (SUI) by measuring the expression levels of TIMP-3, PACAP, and VIP in the vaginal wall and analyzing their correlation to understand the pathogenesis of female SUI. Forty female patients who were admitted to our hospital for tension-free obturator tape surgery for treatment of SUI from April, 2012 to December, 2015 were selected as the study group. Forty patients who underwent vaginal or total abdominal hysterectomy for treatment of non-estrogen-related diseases during the same period were selected as the control group. Tissue samples from the anterior vaginal wall, located at twelve o'clock, were taken from both groups. The expression levels of TIMP-3, PACAP and VIP were detected by immunohistochemistry, and the correlation of integral optical density (IOD) among expressions of TIMP-3, PACAP, and VIP was investigated. The expression of TIMP-3 in vaginal wall tissues of the study group was lower than that of the control group (P<0.05). The expression of PACAP and VIP in vaginal tissues of the study group were lower than those of the control group (P<0.05). In the study group, the IOD of PACAP expression was significantly and positively correlated with that of VIP (r=0.873, P<0.05), the IOD of PACAP expression was significantly and positively correlated with that of TIMP-3 (r=0.802, P<0.05), and the IOD of VIP expression was significantly and positively correlated with that of TIMP-3 (r=0.716, P<0.05). In conclusion, TIMP-3, PACAP and VIP jointly participate in the occurrence of female SUI. Increasing the expression of TIMP-3, PACAP, and VIP, repairing neurons, and enhancing the elasticity of vaginal wall tissues may become a new way to treat female SUI.

Efficacy and Safety of Tension-Free Vaginal Tape-Secur Mini-Sling Versus Standard Midurethral Slings for Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Purpose:To assess the efficacy and safety of tension-free vaginal tape (TVT)-Secur for stress urinary incontinence (SUI).Methods:A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register.Results:Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O) and TVT. We found that TVT-Secur had significant reductions in operative time, visual analog score for pain, and postoperative complications compared with TVT-O. Even though TVT-Secur had a significantly lower subjective cure rate (P<0.00001), lower objective cure rate (P<0.00001), and higher intraoperative complication rate, compared with TVT-O at 1 to 3 years, there was no significant difference between TVT-Secur and TVT-O in the subjective cure rate (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.22–1.08; P=0.08), objective cure rate (OR, 0.49; 95% CI, 0.22–1.09; P=0.08), or complications at 3 to 5 years. Moreover, TVT-Secur had significantly lower subjective and objective cure rates compared with TVT.Conclusions:This meta-analysis indicates that TVT-Secur did not show an inferior efficacy and safety compared with TVT-O for SUI in 3 to 5 years, even though displaying a clear tread toward a lower efficacy in 1 to 3 years. Considering that the safety is similar, there are no advantages in using TVT-Secur.

TOT Approach in stress urinary incontinence (SUI) – outcome in obese female

BackgroundOnly limited data are available on the outcome of tension-free obturator tape (TOT) procedures in overweight and obese women. We would like to verify the objective and subjective outcomes of TOT in women with a higher body mass index (BMI).MethodsWe evaluated the records of 116 patients who had undergone TOT, stratifying by BMI into normal weight (n = 31), overweight (n = 56), and obese (n = 29) groups. We compared pre- and postoperative evaluations, including subjective and objective outcome of TOT, complications, and quality of life assessed by validated questionnaires (ICIQ-SF and KHQ).ResultsThe median follow-up was 21 months. There were no significant differences between different groups in terms of objective cure rate and subjective success, quality of life scores and postoperative complications.ConclusionsOur data demonstrate that TOT procedure is safe and effective. BMI did not influence the outcome of TOT procedures at a median of 21 months after surgery and represents no contraindication for continence surgery. The success of the outcome of TOT procedure in females and the occurrence of complications are not negatively affected by obesity.

Outcome of tension-free obturator tape procedures in obese and overweight women

Little data are available on the outcome of tension-free obturator tape (TVT-O) procedures in obese and overweight women. We hypothesized that the subjective and objective outcomes of TVT-O in women with a higher body mass index (BMI) would differ from those with a lower BMI. We retrospectively reviewed the records of 129 patients who had undergone TVT-O, stratifying by BMI into normal weight (n = 39), overweight (n = 58), and obese (n = 32) groups. We compared pre- and postoperative evaluations, including subjective and objective outcome of TVT-O, complications, and quality of life assessed by validated questionnaires. The median follow-up was 24 months. There were no significant differences between groups in terms of objective cure rate and subjective success, quality of life scores, or postoperative complications. BMI did not influence the outcome of TVT-O procedures at a median of 24 months after surgery.

Do Periurethral Zuidex Injections Alter the Performance of Tension-Free Tapes in the Treatment of Stress Urinary Incontinence?

Introduction: A proportion of patients with ongoing stress urinary incontinence (SUI) following periurethral injections may wish to consider further intervention in the form of a tension-free obturator tape. This study aims to establish whether the presence of periurethral Zuidex alters the operative procedure or affects the success rate of subsequent tension-free tape surgery. Patients and Methods: In a study of 200 consecutive female patients suffering from SUI managed with the urethral bulking agent Zuidex we reported a 62% success rate. Twenty-two of 76 patients who continued to suffer from SUI following periurethral Zuidex opted for further surgical intervention in the form of a tension-free tape. The median age of the patients was 63 years and the time between Zuidex treatment and tension-free tape insertion ranged from 5 to 31 months (median 6.8 months). Results: The presence of the bulking agent did not alter surgical technique or increase the complexity of tape insertion. Twenty of 22 (91%) women were pad free after tension-free tape and 2 patients reported an increase in lower tract symptoms (cystoscopy normal). Conclusions: In our experience the success of transobturator tape surgery for stress incontinence is not adversely affected by the previous use of periurethral injections of Zuidex.

Comparison of TVT and TVT‐O in patients with stress urinary incontinence: Short‐term cure rates and factors influencing the outcome. A prospective randomised study

Recently, mid-urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI). To investigate tension-free vaginal tape (TVT) and tension-free obturator tape (TVT-O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints). One-hundred and sixty-four patients were included in the study (n = 81 for TVT, n = 83 for TVT-O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q-tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures. The cure rates were similar in TVT and TVT-O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT-O group (P = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility (P = 0.001). The TVT and TVT-O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid-urethral slings.

Incidence and Risk Factors of Postoperative De Novo Voiding Dysfunction following Midurethral Sling Procedures

Purpose: To compare the incidence of postoperative de novo voiding dysfunction and to identify the risk factors affecting the development of de novo voiding dysfunction after various midurethral sling (MUS) procedures for female stress urinary incontinence (SUI). Materials and Methods: Women with SUI underwent MUS by various procedures [tension-free vaginal tape (TVTR), tension-free vaginal tape obturator (TVTOR), tension-free obturator tape (TOTR), or TVT-secureR]. Cases were reviewed retrospectively with follow-up of at least 6 months. The subjects were divided into 2 groups according to the presence of postoperative de novo voiding dysfunction. De novo voiding dysfunction was defined as a low maximal uroflow rate (Qmax 100 ml) observed at 6 months postoperatively. Clinical and urodynamic parameters were compared between the voiding dysfunction (Group I) and normal voiding (Group II) groups according to MUS procedure. Results: Of the 625 subjects, 163 (26%) patients showed evidence of de novo voiding dysfunction (Group I). Of these 163 subjects, 12 (7.3%) patients complained of voiding symptoms. There was no difference in the incidence of de novo voiding dysfunction according to MUS procedure. Multivariate analysis showed Qmax to be the only independent risk factor for de novo voiding dysfunction. Conclusions: This study confirmed the considerable incidence of postoperative de novo voiding dysfunction, which is, however, mostly asymptomatic. As preoperative Qmax decreased, the chance of postoperative de novo voiding dysfunction increased. Identification of risk factors of voiding dysfunction in women undergoing MUS may help in planning for better follow-up and early detection of possibly inherent late complications of voiding dysfunction. (Korean J Urol 2009;50:762-766) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Einfluss von Persönlichkeit auf die Lebensqualität nach einer Harninkontinenzoperation: Ergebnisse nach spannungsfreier transobturatorischen Tape-Implantation (TOT)

We evaluated the two-year follow-up results for tension-free obturator tape operations by comparing patients before (n = 64) and after (n = 204) the procedure, using the King's Health Questionnaire and the Giesen test. A psychometric analysis of the two groups showed an improved quality of life (with particular focus on the social impact, day-to-day activities, stress due to incontinence, sleep disturbance and general health). The success of the operation could not be explained by personality factors. Subjective cure rates of 79.9 % together with an improved ability to form social contacts demonstrated the success rate of the innovative TOT method.

Tension-free obturator tape (Monarc Subfascial Hammock) in patients with or without associated procedures

The aim of the present study was to evaluate the safety and efficacy of the tension-free obturator tape (TOT) procedure in patients having concomitant hysterectomy and/or pelvic reconstructive surgery. A chart review from August 2002 to December 2004 identified 341 consecutive female patients with stress urinary incontinence who had undergone a TOT procedure alone (Monarc only group) or a TOT procedure associated with hysterectomy or other pelvic reconstructive surgery (Monarc + other surgery group). Intraoperatively, three cases of hemorrhage occurred. No transfusions were required. There were no cases of bladder injury or injury to obturator nerves or vessels during needle passage via the transobturator route. Three cases of vaginal erosion were found at 3 months follow-up, but no tape removal was required. Two hundred fifty-four patients (74.5%) were contacted by telephone for a second follow-up (average 17 months, range 6-32) and the validated short forms of the Urogenital Distress Inventory (UDI-6) questionnaire and of the Incontinence Impact Questionnaire (IIQ-7) were administered. Results showed a very good quality of life score (0-7) in 93.3% patients. Globally, only three (1.2%) patients had persistent urine leakage related to physical activity. Severe voiding dysfunction occurred in five (2%) patients. The cure rate, considered as the complete absence of urine leakage (score 0 in questions 2 and 3 of the UDI-6), was 73.7% in the Monarc only group vs 57.4% in the Monarc + other surgery group. Pelvic floor defects, benign uterine disorders, and stress urinary incontinence can be safely treated with transobturator tape, using the Monarc device, and concomitant vaginal procedures.

Suburethral tape via the obturator route: is the TOT a simplification of the TVT?

Suburethral meshes can be implanted via the classic retropubic route (TVT) or by a new insertion technique that passes the tape into the obturator foramen (TOT). In a retrospective study we compared one 18-month period of 94 TOT (tension-free obturator tape) and one 18-month period of 99 TVT (tension-free vaginal tape), which preceded the change in the approach route. All operations were performed by the same surgeon using the same Prolene mesh and with no other surgical procedure associated. These two series were similar in terms of patient age, previous surgical history, degree of incontinence and preoperative urethral closure pressure. The analysis shows more hemorrhagic complications in the TVT group (10%) than in the TOT group (2%), but the difference was not significant. Bladder injuries were more frequent in the TVT group (10%) than in the TOT group (0%), but there was one urethral injury in the TOT group. The mean follow-up was 29.5 months in the TVT group and 12.8 months in the TOT group. The urinary results were the same, with 90% and 95% cured, respectively. In conclusion, the obturator approach shows identical urinary results to the classic retropubic approach. Because of the nature of the procedure, major hemorrhage and bowel perforation are excluded in the TOT procedure. Thus simplicity, safety and continence result mean that the obturator approach represents the best method of suburethral tape insertion for the treatment of urinary stress incontinence.