Tension-free Tape Research Articles

Fertilität und Inkontinenz

Purpose: The Ulmsten technique of tension-free transvaginal prolene tape placement can lead to long-term stabilization. However, to date there is no literature investigating the position of the prolene tape during pregnancy or after birth. The tape position and function, the clinical course of the pregnancy and the results postpartum were investigated. Material and Methods: We present here a 41-year-old gravida VI/para VI who had undergone placement of a TVT tape after the fourth pregnancy. Both pregnancies occurring after this incontinence operation were delivered by caesarean section. Regular sonographic controls to ascertain the position of the tape were carried out. Results: Neither of the pregnancies led to any alteration in the position or the functioning of the tape. The patient remained continent and experienced no discomfort even after the second pregnancy. Conclusion: Caesarean delivery can preserve the position and function of the TVT tape over time even after more than one pregnancy.

Erste Erfahrungen mit der infrakokzygealen Sakropexie nach Petros bei Vaginalprolaps und Harndranginkontinenz

Objective: The infracoccygeal sacropexy (ICS) according to Petros is a surgical procedure with a tension free tape for repair of vaginal vault prolapse. Corresponding to Petros even functional disorders like urinary urgency and nocturia are improved. The aim of this study was to report our experience with ICS. Methods: The infracoccygeal sacropexy was performed on 13 patients with vaginal vault prolapse and 8 with uterine prolapse and enterocele. Urodynamics preoperatively revealed urge incontinence (detrusor instability). The incontinence score was checked pre- and postoperatively with the Gaudenz questionnaire. Results: Preliminary results after 6 months revealed an improvement of urge incontinence in 16 out of 21 patients (76%). The non-responders (24%) to the ICS procedure - concerning relief of urge symptoms - had a history of hysterectomy and previous surgery in the anterior compartment. No recurrence of prolapse was observed. There were no severe intra- or postoperative complications. Conclusions: Infracoccygeal sacropexy is a new surgical procedure for restoration of vaginal vault and uterine prolapse. Additionally urinary urge incontinence is improving. Patients with scar tissue at the bladder neck as a consequence of previous surgery have no benefit according to this study from ICS procedure in concern to relief of urge symptoms.

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.