Tension-free Tape Research Articles

Retropubic tape surgery for stress urinary incontinence: can women be cured without voiding dysfunction?

Retropubic tension free vaginal tape (RP-TVT) has become the gold standard for surgical management of female stress urinary incontinence but is associated with voiding dysfunction (VD). We developed for more than 10years a reproductible and totally tension free tape procedure. Our goal is to determine efficiency of this technique compared to the incidence of VD. We retrospectively reviewed patients who underwent RP-TVT in our center between 2011 and 2019. Subjective cure, VD (determined as maximum urinary flow rate (Qmax) < 15mL/s or post void residual (PVR) volume > 150mL, or tape's section or resection requirement for underactive bladder (UB) with significant PVR) was assessed at 1year. The main objective was the evaluation of subjective cure and VD at 1year. On the 319 patients reviewed, 93% of the patients were dry and 10.9% presented VD at one year. UB (OR = 5.01 [1.55-16.44], p = 0.008), preoperative Qmax < 15mL/s (OR = 0.89 [0.84-0.95], p = 0.001) and previous incontinence surgery (OR = 4.20 [1.54-11.46], p = 0.005) were associated with VD. Acute urinary retention concerned 4.7% of the population and all were resolved after 6weeks postoperatively. We reported 0.3% of de novo urgency and patients without VD showed a significant decrease of their voiding time at 1year. The placement of RP-TVT without intraoperative tightening seems to be a safe technique ensuring a high cure rate and low occurrences of bladder outlet obstruction.

Sunt meşele necesare în tratamentul incontinenţei urinare de efort la femei?

Introduction. Stress urinary incontinence (SUI) impacts over 20% of women, and its prevalence is increasing with the aging of population. This review assesses mesh surgery for SUI treatment by analyzing midurethral slings, retropubic urethropexy, bulking agents and artificial sphincters. Methodology. We searched the PubMed database from 1995 to 2023 inclusive, and 31 studies met our inclusion criteria, focusing on women aged 20-70 years old with SUI, excluding nervous system diseases affecting the function of the bladder. Results. Minimally invasive midurethral slings – particularly transvaginal tension-free tape (TVT) and transobturator tension-free vaginal tape (TOT) – have become the standard of care, endorsed by the Food and Drug Administration (FDA) in 2011. TVT offers reduced hospital stays and shorter operating times, with risks including bladder perforation and infections. TOT, while minimizing bladder perforation risks, may increase groin pain. Mini-slings and autologous fascial slings show varying success; the latter has higher success but more complications than Burch colposuspension. Retropubic urethropexy is effective on the long term, but with longer recovery and more complications. Conclusions. Mesh-based midurethral slings (MUS) are pivotal in SUI treatment, providing high short-term success and enhanced quality of life. Effective SUI management requires individualized treatment, with a fine balance between benefits and risks. With emerging regenerative medicine, the future of SUI treatment is promising. Until then, MUS remains a key modality, necessitating careful patient selection and ongoing research to refine the surgical outcomes and improve the quality of life for SUI patients.

What is the Evidence between Tension-Free Tapes and Burch Surgery for Stress Urinary Incontinence in the Terms of Quality of Life?: A Systematic Review

What is the Evidence between Tension-Free Tapes and Burch Surgery for Stress Urinary Incontinence in the Terms of Quality of Life?: A Systematic Review

Narrow Vagina as a Predictor of Obstructive Voiding Dysfunction after Transobturator Sling Surgery

Background: Voiding dysfunction (VD) is a potential complication after female midurethral sling operations. Objectives: Our goal was to assess the rate of obstructive VD after ­transobturator tension-free tape (TOT) procedures and to find perioperative risk factors (RFs) predicting postoperative voiding problems. Methods: We have retrospectively evaluated the perioperative data of 397 women who underwent TOT operations. Significant post-void residual (PVR) (>50 mL) was considered as the primary (objective) end point of the study, the voiding difficulty as the secondary (subjective) 1. First univariate analysis and then multivariate logistic regression were performed, with a 5% significance level. Results: Significant PVR was present in 51 (12.8%) women; catheterization was needed in 21 (5.3%) and reoperation in 3 (0.8%) cases. Seventy women (17.6%) experienced postoperative voiding difficulty. Narrow vagina (<2 cm), older age >70 years, and preoperative voiding difficulty were independent RFs for significant PVR (odds ratio: 5.07, 2.14, 5.38, respectively, p < 0.05). Preoperative overactive bladder syndrome and previous pelvic organ prolapse surgery were considered independent RFs for postoperative voiding difficulty. Conclusions: Older age, narrow vagina, or preoperative voiding difficulty increases the chance for significant postoperative PVR. These patients should be chosen and counseled appropriately.

Increased Body Mass Index and Success Rate of Tension-free Tape Surgery

Amaç: Literatürde tension-free obturator tape (TOT) cerrahisinin kilolu ve obez kadınlardaki sonuçları ile ilgili çok az veri mevcuttur. Bu çalışmanın amacı; vücut kitle indeksinin (VKİ) TOT cerrahi başarısına olan etkisini, hasta memnuniyetini ve cerrahi sonrası 1 yıldaki komplikasyonları değerlendirmektir. Gereç ve Yöntem: Stres üriner inkontinans (SUI) şikayeti ile TOT ameliyatı olmuş 96 hasta çalışmaya dahil edildi. Ameliyat sonrası hastalar en az 1 yıl takip edildi. Hastaları VKI’leri ile Dünya Sağlık Örgütü (WHO) sınıflandırmasına göre 3 gruba ayırdık. Grup 1 (normal VKİ &amp;lt;25 kg/m2), Grup 2 (kilolu VKİ 25-30 kg/m2), Grup 3 (obez VKİ &amp;gt; 30 kg/m2). Subjektif ve objektif sonuçlar, komplikasyonlar ve hastaların yaşam kaliteleri valide edilmiş sorgu formları ile (UDI-6, IIQ-7) değerlendirildi. Sonuçlar gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya dahil edilen 96 hastanın 32 tanesi normal kilolu, 32 tanesi kilolu ve geri kalan 32 tanesi de obez idi. Komplikasyon oranları gruplar arasında istatistiksel olarak anlamlı değildi (p&amp;gt;0.05). Tüm gruplarda hastaların UDI-6 ve IIQ-7 skorlarında 1 yıllık takipte başlangıç değerine belirgin düşüş izlendi. Tüm gruplarda 1 saatlik ped testi ve öküsürük testi (grup 1’de %71.8 ve grup 2 ve grup 3’de %84.3) sonuçlarına göre belirlenen toplam objektif kür oranı %80.2 (96 hastadan 77 tanesi ) idi. Gruplar arasında istatistiksel olarak anlamlı fark yok idi. Sonuç: TOT cerrahisi objektif ve subjektif başarı oranları tüm VKİ’ne sahip hasta gruplarında benzer olarak izlendi. Artmış VKİ oranları ile komplikasyon oranları artmamaktadır.

A low cost artisan tension-free tape technique cures pelvic organ prolapse and stress urinary incontinence - proof of concept.

IntroductionThe primary cause of pelvic organ prolapse (POP) is weak cardinal/uterosacral (CL/USL) ligaments and for stress urinary incontinence, weak pubourethral ligaments (PUL).Material and methodsA 1 cm wide tape cut from a mesh sheet was applied tension-free to reinforce already plicated CL/USLs for cure of prolapse and directly to PUL for cure of stress urinary incontinence (SUI). 40 tapes were inserted, 10 midurethrally for SUI and 30 for 2nd/3rd degree prolapse: 15 to uterosacral ligaments and 15 to cardinal ligaments.ResultsAt 12 months follow-up there was 72% cure for POP, 70% for SUI and improvement in urge/nocturia symptoms in 82% of patients.At 36 months 8/15 patients were evaluated. Anatomic cure for POP III was 2/4, for POP I-II 6/6.ConclusionsThough a ‘proof of concept’ study, our results may be sufficient to provide, in time, an alternative individual pathway for surgeons wishing to provide more certainty to a prolapse repair than ‘native tissue’ for an individual patient. The method questions whether expensive mesh kits are really necessary: our data though small, actually part of a learning curve, was within 15 percentage points of more sophisticated, more expensive tensioned slings. Intraoperative complications were low with no tape erosions seen at 12 months. Further validation with larger prospective and comparative trials is required.

Kinesio taping is superior to other taping methods in ankle functional performance improvement: a systematic review and meta-analysis

Objective: To compare the effect of Kinesio taping on ankle functional performance with that of other taping methods (non-elastic taping) in healthy individuals and patients with ankle sprain. Methods: A search was performed in electronic databases (MEDLINE, Embase, Cochrane Library, and China National Knowledge Infrastructure) for studies published up to 31 March 2018 using the following keywords: ankle, Kinesio taping, KT, and tape. Studies on ankle functional performance were selected, and data on Star Excursion Balance Test results, vertical jump height, and range of motion were extracted. Meta-analyses (where appropriate and possible) using either fixed or random effects model, standardized mean differences, and tests of heterogeneity were performed. Results: Ten studies fulfilled the inclusion criteria. The Star Excursion Balance Test results indicated that Kinesio taping was superior to other taping methods (placebo taping or tension-free taping). The mean difference was 3.2 (95% confidence interval (CI): 0.84–5.59, I2 = 5%, P = 0.008). In studies in which vertical jump height was measured, a negative effect was observed for other taping methods (athletic taping or placebo taping), but not for Kinesio taping (mean difference = 1.06, 95% CI: 0.19–0.93, I2 = 15%, P = 0.02). Both Kinesio taping and common taping had no significant effect on range of motion, with no differences between these methods (I2 = 0%, P = 0.80). Conclusion: Kinesio taping is superior to other taping methods (athletic taping) in ankle functional performance improvement.

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%.

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

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

Tomographic Ultrasound Imaging to Control the Placement of Tension-Free Transobturator Tape in Female Urinary Stress Incontinence.

Purpose. The objective was to evaluate, by means of tomographic ultrasound imaging (TUI), the reliability of a novel approach for determining the position of the implanted tension-free transobturator tape (TOT). Furthermore, we analyzed the association between the position of the tape at rest and the subjective cure in stress incontinent women. Methods. This retrospective pilot study consists of 32 stress incontinent women, who underwent TOT procedure and routine sonographic control at day 1 postoperatively and at follow-up visit. TUI was applied on the resulting 4D volumes, thereby delivering 9 axial slices with a 4 mm interslice distance starting at the meatus urethrae internus in caudal direction. The reliability of the approach was tested by two examiners. Postoperative and follow-up ultrasound parameters of uncured and cured patients were analyzed. Results. Measurements of the position of the TOT demonstrated high intraclass correlation coefficients. We found minor differences between sonographic parameters at day 1 postoperatively and at follow-up after a median period of 321 days. In cured patients, the position of the tape was measured in a more caudal position than in uncured patients. Conclusions. TUI can be a reliable method for determining the position of the tape. Further studies are needed to evaluate whether the postoperatively determined position can be used as an indicator of future subjective cure.

Robotic Resection of Intravesical Polypropylene Mesh Following Tension Free Tape Procedure

Robotic Resection of Intravesical Polypropylene Mesh Following Tension Free Tape Procedure

Patellar taping alters knee kinematics during step descent in individuals with a meniscal injury: An exploratory study

BackgroundMeniscus lesions are common musculoskeletal knee injuries which often lead to pain, limitation and compensations during functional tasks, such as descending stairs. This study investigated the effect of patellar taping with tension and without tension on three-dimensional (3D) kinematics of the knee during a slow step descent task in patients with meniscal lesions. MethodsTen patients diagnosed with a meniscal lesion, confirmed by magnetic resonance imaging, underwent five, step descent movements at slow speed under three different conditions: 1) no taping; 2) tension-free taping; and 3) patellar taping with medial tension. 3D kinematic data were recorded from the injured knee using an eight-camera infrared Vicon motion analysis system. Maximum and minimum angle values and total range of motion (maximum/minimum value) in three movement planes during single-limb stance were compared using a repeated measure ANOVA. FindingsResults showed a significant increase in the maximum and minimum angle value in the sagittal plane (mean differences=2.4° and 4.2°, respectively) and a decrease in the transverse plane (−6.3° and −2.2°, respectively) for the patellar taping condition compared to the no taping condition. A decreased rotational angle range when comparing the patellar taping to the no taping (−4.1°) and tension-free taping (−3.1°) conditions was also observed. These changes remained significant when pain was considered as a covariate in the analysis. The tension applied to the patellar tape played a role in controlling the sagittal and transverse plane step-down movement among patients in our study. InterpretationThese results support the use of patellar taping with a medially oriented tension to help to reduce the transversal plane movement of the knee in this population and they bring new light to the taping effect.

Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis.

Questions regarding the long-term efficacy and safety of midurethral slings (MUS) are still unresolved, notwithstanding the widespread use of these procedures. The objective of this review was to evaluate the long-term outcomes of retropubic MUS (RP-MUS) procedures and the medium-term outcomes of transobturator MUS (TO-MUS) procedures. MEDLINE, EMBASE, NLH, ClinicalTrials.gov, and Google Scholar databases were searched up to June 2014 with restriction to English language and using the search terms: "stress urinary incontinence", "midurethral sling", "tension-free tape", "transobturator tape", and "follow-up". Studies with a follow-up of 36 months for TO-MUS and 60 months for RP-MUS were searched. Only studies comparing a RP-MUS or TO-MUS with another synthetic sling were included. Data from 49 studies were included. Data were expressed as odds ratios (OR) with 95 % confidence intervals (CI) and combined using the Mantel-Haenszel fixed effects model. Differences in the proportions were evaluated using the chi-squared test. RP-MUS had similar objective cure rates (OR 1.15, 95 % CI 0.75 - 1.76) but higher subjective cure rates than TO-MUS (OR 1.76, 95 % CI 1.08 - 2.86). No differences were observed between outside-in (TOT) and inside-out (TVT-O) and between TO-MUS and minisling. Bladder injuries were more frequent (OR 7.01, 95 % CI 2.94 - 17.90) and vaginal erosions were less frequent for RP-MUS (OR 0.24, 95 % CI 0.07 - 0.84). Vaginal injuries were more common with TOT than with TVT-O (OR 7.96, 95 % CI 1.15 - 157.9). Pain-related complications were more common with TO-MUS than with minimally invasive tapes (OR 8.75; 95 % CI 9.02 - 57.90). MUS have similar objective cure rates in the long term and medium term. TO-MUS is associated with a lower subjective cure rate than RP-MUS.

Robotic Resection of Intravesical Polypropylene Mesh following Tension-Free Tape Procedure

To present a case of intravesical TVT mesh remote from insertion and demonstrate one possible technique for resection of the retropubic mesh arms. Tension-free vaginal tape (TVT) is the mainstay of treatment for stress urinary incontinence, and though major complications are rare, most are associated with the blind passage of the TVT trocars through the retropubic space. This video reviews TVT complications and treatment options for intravesical polypropylene mesh. This introduction is followed by a case presentation of a 43 year old para 2 female who underwent laparoscopic robotic removal of TVT after two years after the initial procedure. There are several options for surgical treatment of intravesical mesh issues following TVT, including vaginal, laparoscopic (with or without robotic assistance), and open procedures which can either completely or partially remove the polypropylene mesh depending on the TVT issues in question (intravesical mesh, pelvic pain, dyspareunia, etc.). This video demonstrates our preferred method of laparoscopic robotic assisted removal of the retropubic TVT arms in cases of intravesical mesh remote from initial surgery.

Laparoscopic interval isthmocervical cerclage with cardiac tape in a patient with previous cervical amputation.

To show the technique of interval laparoscopic isthmocervical cerclage using cotton cardiac tape. Case report (Canadian Task Force Classification III). A private practice hospital in Brasília, Brazil. A 36-year-old female patient with primary infertility for 2 years caused by previous amputation of the cervix because of intraepithelial neoplasia. There was no other suspected factor for infertility. Before undergoing in vitro fertilization, she was referred for interval cerclage because of anticipated cervical insufficiency during an eventual pregnancy. The patient's clinical history was unremarkable, except for the fact that she had developed secondary dysmenorrhea since the amputation, which prompted her to undergo cervical dilatation on 2 occasions. During the physical examination, we noted the absence of the exocervix, a mobile and normal-sized uterus and adnexa, and no pain. Informed consent was obtained from the patient for this case report. The local institutional review board considered this report exempt from approval. The procedure was performed according to the technique described by Pereira et al. We incised the visceral peritoneum in the anterior cul-de-sac and developed the vesicouterine space for complete exposure of the uterine isthmus. Then, we incised the posterior leaf of both broad ligaments superiorly to the uterosacral ligaments and medially to the ureter and uterine vessels. We aimed to identify the bifurcation of the uterine artery and to create a "window" between them and the isthmus to place the cerclage tape. For this purpose, we used a 5-mm 36-cm blunt tip retractor for gastric banding (ref 30623G; Karl Storz, Tuttlingen, Germany) to transfix the broad ligament, anteriorly to posteriorly, under direct vision. We tied 2-0 Vicryl (Ethicon, Sommerville, NJ) sutures to the tips of 0.3 × 80 cm cotton cardiac tape (reference FAB-46; Ethicon) and pulled both edges of the tape through the windows in the broad ligament. The final position of the tape was inferior and medial to the main ascending branch of the uterine artery, right over the isthmus, and without any vessels interposed between them. This is to avoid any possible compression and congestion with uterine progressive enlargement as pregnancy proceeds. We then made 6 square knots in the anterior cul-de-sac and adjusted the tension-free tape firmly enough to give the uterine corpus support during pregnancy evolution. Finally, we closed the visceral peritoneum with a 3-0 PDS running suture (Ethicon). The surgery lasted 70 minutes, and bleeding was minimal. The patient was discharged the following day. She is currently undergoing her 18th week of pregnancy resulting from in vitro fertilization treatment, and we wait for her obstetric results. Cotton cardiac tape is feasible for laparoscopic cerclage and can be used as an alternative to the commonly used Mersilene tape (Ethicon). Laparoscopy safely allows tape placement medial to the uterine vessels. Additional cases are necessary to establish the obstetric effectiveness of cotton cardiac tape for laparoscopic cerclage.

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.

Intraoperative Crede Maneuver for Tape Adjustment During Transobturator Sling Placement

This study evaluated the efficacy of intraoperative extrinsic manual compression on the bladder, or Crede maneuver (CM) for tape adjustment during transobturator tape (TOT) sling procedure versus the traditional method where tension-free tape is adjusted the same for all patients. All patients undergoing TOT sling procedure for stress urinary incontinence (SUI) between May 2008 and June 2011 by the first author were assessed. Tape adjustment was either performed in a traditional manner, leaving a tonsil clamp-size space between the sling and posterior urethra, or by using CM after filling the bladder to 300 ml capacity. Patients were considered cured at postoperative visits if they had no SUI symptoms and negative Cough Stress Test (CST) result, improved if they had some SUI symptoms and negative CST result, and failed if symptomatic and had positive CST result. The Fisher exact test and the Wilcoxon rank sum test were used to evaluate the baseline differences between the 2 groups, along with multiple logistic regression to evaluate independent predictors of cure. The continence rate was 77.67% in the traditional group (87/112) and 79.65% (137/172) in the CM group (P = 0.76). Older patients and smokers were less likely to be continent (odds ratio, 0.95; P = 0.015; and odds ratio, 0.22; P = 0.003, respectively). Five (4.5%) of the 112 patients in the traditional group and 12 (6.9%) of the 172 patients in the CM group had adverse outcomes including transient urinary retention, mesh erosion, or dysuria (P = 0.45). Using CM for intraoperative tape adjustment does not improve continence rates compared to the traditional method of TOT sling placement.

Results of the surgical correction of urinary stress incontinence according to the type of transobturator tape utilized

To analyze the short and long term results of tapes of different materials used to treat stress urinary incontinence (SUI). A secondary objective was to evaluate the ability to adjust the tape after implantation. Retrospective chart review of 355 patients with SUI operated between March 2003 and October 2011. Eight different types of transobturator tapes were used: Gynecare TVT-O®, Monarc®, SAFYRE®, Contasure KIM®, I-Stop®, DynaMesh®, Aris® Bandellete and Swing-band®. Results and complications were recorded. The mean age at operation was 61 years. Correction of SUI was achieved in 87.88% of cases. The best results were obtained with Contasure KIM® (98.26 % continence). The tape was well tolerated and was elastic enough to be able to be adjusted 48-72 hours after implantation without deformation. Slings with macropores and over lock stitches on the superior and inferior borders presented the lower rates of postoperative urinary retention, pain, perior postoperative bleeding and urinary tract infections. Transobturator tension free tapes require a short operation time and have a low complication rate. The possibility of adjustment in the early postoperative period increases the success rate and reduces complications. Knotless meshes with macropores and over lock stitches appear to be better balanced, are quite resistant to stretching and deformation when readjusted after implantation and present a low infection rate.

A technique for removal of intravesical tension-free tape and

A technique for removal of intravesical tension-free tape and

Urinary Incontinence and Retention in the Female Neobladder Why Does This Occur and Treatment Options?

A rising number of female patients with transitional cell carcinoma of the bladder are treated with orthotopic bladder replacement using an ileal neobladder. This method has two major drawbacks that may occur post-operatively, i.e., incontinence or increased residual urine up to urinary retention. The purpose of this review is to provide an overview of the pathophysiology and possible treatment options. The treatment options of urinary incontinence in general are different kinds of tension-free tapes and the artificial sphincter; however, possibilities to treat chronic retention are very limited and can be reduced by modifications during the surgical procedure itself by creation of a low-pressure neobladder.