Tension-free Vaginal Tape Group Research Articles

Innovative decision making tools using discrete mathematics for stress urinary incontinence treatment.

In this study, we applied graph theory to clinical decision-making for Stress Urinary Incontinence (SUI) treatment. Utilizing discrete mathematics, we developed a system to visually understand the shortest path to the desired treatment outcomes by considering various patient variables. Focusing on women aged 35-50, we examined the effectiveness of Tension-free Vaginal Tape (TVT) surgery and Vaginal Erbium Laser (VEL) treatment for over 15years. The TVT group consisted of 102 patients who underwent surgery using either the Advantage Fit mid-urethral sling system (Boston Scientific Co., MA, USA) or the GYNECARE TVT retropubic system (Ethicon Inc., NJ, USA). The VEL group included 113 patients treated with a non-ablative Erbium: YAG laser (FotonaSmooth™ XS; Fotona d.o.o., Ljubljana, Slovenia), and there were 112 patients in the control group. We constructed a network diagram analyzing the correlations between health, demographic factors, treatment methods, and patient outcomes. By calculating the shortest path using heuristic functions, we identified significant correlations and treatment effects. This approach supports patient decision making by choosing between TVT and VEL treatments based on individual objectives. Our findings provide new insights into SUI treatment, highlighting the value of a data-driven personalized approach for clinical decision-making. This interdisciplinary study bridges the gap between mathematics and medicine, demonstrating the importance of a data-centric approach in clinical decisions.

Quality of life and sexual function after tension-free vaginal tape and polyacrylamide hydrogel injection for primary stress urinary incontinence: 3-year follow-up from a randomized clinical trial

Introduction and hypothesisTo assess quality of life (QoL) and sexual function outcomes at 3 years after tension-free vaginal tape (TVT) and polyacrylamide hydrogel injection (PAHG) for stress urinary incontinence (SUI).MethodsIn this randomized trial comparing TVT (n = 104) and PAHG (n = 108), we assessed changes in QoL and sexuality using the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire, Short Form (IIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and RAND-36 Item Health Survey (RAND-36) at baseline and at 3 years. This is a secondary analysis of a randomized, noninferiority trial comparing patient satisfaction after TVT and PAHG.ResultsIn both groups, incontinence-related QoL improved from the baseline (p < 0.00), except for difficulty emptying the bladder and pain/discomfort. Total scores of UDI-6 and IIIQ-7 were lower for TVT compared to PAHG (p < 0.00) indicating better QoL at 3 years. Urinary incontinence with sexual activity or fear of incontinence restricting sexual activity improved in both groups (p < 0.00), with higher scores for physical section subscale in PISQ-12 (p = 0.02) for TVT. Physical and social functioning (RAND-36) improved from the baseline in both groups (p < 0.01) with a better outcome in the TVT group for physical functioning (p = 0.00).ConclusionsBoth TVT and PAHG improve QoL and sexual function in primary SUI with better incontinence and health-related QoL scores in the TVT group compared to the PAHG group at 3 years.

The Transobturator Tape Versus Retropubic Tension-Free Vaginal Tape in the Treatment of Comorbid and Elderly Women With Stress Urinary Incontinence: A Retrospective Analysis of Over 800 Women.

Background and objective The first-line surgical treatment for female stress urinary incontinence (SUI) involves midurethral slings (MUS), including the transobturator tape (TOT) and the retropubic tension-free vaginal tape (TVT). However, whether offering these procedures to older and comorbid womencould lead to increased complications is a question that needs to be seriously addressed. In this retrospective cohort study, we aimed to compare the two procedures and evaluate the impact of age, BMI, and comorbidities on complications. Materials and methods A total of 873 procedures (306 TVTs/567 TOTs) performed between 2007 and 2017 were compared and correlated with regard to age, BMI, and comorbidities. Intraoperative complications includedbleeding >50 ml, bladder injury, and anesthesia-associated complications. Postoperative complications includedpost-void residual volume, pain, hematoma, lower urinary tract infection, revision for loosening tape, and bladder infections. The comorbidities were evaluated based on theAmerican Society of Anesthesiologists (ASA) and Charlson scores. Results A total of 873 MUS were conducted during the study period: 306 TVTs and 567 TOTs. Groupwise comparison between these procedures showed that women in the TOT group were older(p<0.001) with a higher BMI (p<0.001) and a higher ASA score (p<0.001) compared to the TVT group. Nevertheless, significantly more intraoperative complications, especially bladder injuries, were recorded in the TVT group.Postoperative complications occurred in 19.4% of the entire cohort, especially increased post-void residual volume. Postoperative hematoma and tape loosening were significantly more frequent in the TOT group. Age, BMI, and comorbidities showed no significant impact on intraoperative complications; however, the TOT procedure was associated with significantly fewer intraoperative complications [p=0.001, odds ratio (OR): 0.281]. Conclusions Overall,both procedures were associated with a low number of perioperative complications. The TOT technique had a lower incidence of intraoperative complications. It must be highlighted that age and comorbidities had no influence on either the intra- or postoperative complication rates. Hence, we recommend that TOT is employed to treat SUI in older, more obese, and comorbid women.

Comparative Outcomes of Surgical Treatments for Primary Stress Urinary Incontinence in Women: A Retrospective Cohort Study

Introduction: The study evaluates the outcomes of different surgical techniques, including Tension-free Vaginal Tape (TVT), Trans-Obturator Tape (TOT), Burch Colpopexy (BC), and Anterior Vaginal Wall Prolapse Repair (APR), in treating primary stress urinary incontinence (SUI) in women. Materials and Methods: A retrospective cohort study was conducted in a tertiary care center, comprising 62 women diagnosed with primary SUI who underwent one of the aforementioned surgical procedures. Demographic and clinical variables were analyzed, including age, BMI, menopausal status, reproductive history, incontinence types, anticholinergic use, and preoperative assessments. Results: No differences were found in age (p=0.227), weight (p=0.943), height (p=0.333), and BMI (p=0.642) among the four treatment groups. The distribution of menopausal patients and reproductive history variables did not differ among the groups. Postoperative anticholinergic prescription rates (p=0.769) and duration of use (p=0.531) were not different across the groups. The majority of patients in the TVT, TOT, and BC groups had a grade 2 cystocele (p=0.065). The BC group had 100% grade 1 rectocele, which was not significant compared to other groups (p=0.126). Conclusion: Our results showed no potential difference in comparable outcomes among TVT, TOT, BC, and APR for the surgical treatment of primary SUI.

Evaluation of Female Patient Satisfaction after Midurethral Sling Surgery for Stress Urinary Incontinence

Background: Stress Urinary incontinence (SUI) is a public health condition that affects women worldwide, Patient satisfaction after stress incontinence surgery is influenced by many factors, patient-specific expectations, postoperative continence status, and complications. Traditionally treatment success has been defined by cure rate and symptom improvement, patient-reported outcomes, particularly satisfaction, have been recognized as complementary measures of success, This study amid to evaluate patient satisfaction post sling surgery for stress urinary incontinence. Methods: It is a retrospective study including 30 female patients, 15 underwent Transobturator Vaginal Tape (TOT) operation and 15 underwent Tension-free vaginal tape (TVT) for stress urinary incontinence between Jan 2019 to Jan 2020 in Urology Department, Faculty of Medicine, Zagazig University. Patients were evaluated 12 month post MUS for complications and satisfactions by(ICIQ-SF) score, quality of life score , female sexual function index, and Global response assessment scale.Results: Marked improvement in International consultation on incontinence Questionnaire –Short Form and quality of life (ICIQ-SF) score dropped from (12.20±2.27) to (1.40±0.51) TOT group and from (11.26±2.15) to (1.06±0.23) in TVT group. The Quality of life score improved by dropping from (5.26±1.22) to (0.48±0.11) and from (5.06±1.09) to (0.51±0.11) in TVT group with no significant difference between both groups. All items of (FSFI) score were improved from pre to post-management without difference between both groups. Conclusions: Mid urethral slings have high patient satisfaction rates regarding the improvements in ICIQ-SF scores and FSFI on short-term and are relatively safe procedures

Comparison of urethral sling surgery and non-ablative vaginal Erbium:YAG laser treatment in 327 patients with stress urinary incontinence: a case-matching analysis

Stress urinary incontinence (SUI) occurs when abdominal pressure, such as from coughing or sneezing, causes urine leakage. We retrospectively compared tension-free vaginal tape (TVT) and non-ablative vaginal Erbium:YAG laser treatment (VEL) by propensity score (PS) analysis in women with SUI. No PS analysis studies have investigated urethral sling surgery using polypropylene TVT and VEL for SUI. Data from patients aged 35–50 years who were treated for SUI and registered at several institutions were selected. Patients with medical records covering 1 year for the 1-h pad test, who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Overactive Bladder Symptom Score (OABSS), were included. We analyzed 102, 113, and 112 patients in the TVT, VEL, and control groups, respectively. Compared with the control group, the TVT and VEL groups exhibited significant improvement in the 1-h pad test and ICIQ-SF. In the PS analysis, the TVT and VEL groups similarly improved in the 1-h pad test and ICIQ-SF. As for the OABSS, the VEL group showed significantly greater improvement than the TVT group. In the odds ratio analysis for the 1-h pad test, no differences in any of the parameters were observed between TVT and VEL. VEL may be considered an alternative to TVT for SUI treatment.

Management of post-operative urinary incontinence after midurethral sling explantation for pelvic or perineal pain.

The objective was to report the management of post-operative urinary incontinence after midurethral sling (MUS) revision for chronic pelvic pain (CPP), and to report functional outcomes. From November 2004 to February 2018, a total of 89 women who underwent removal or section of MUS for CPP, were enrolled. Patients were divided into the transobturator tape (TOT) group (50 patients) and the tension-free vaginal tape (TVT) group (37 patients); 2 patients had had both slings implanted. We report the rate of stress urinary incontinence (SUI) recurrence, the rate of de novo urge urinary incontinence (UUI), the need for subsequent SUI or UUI surgery, and functional outcomes (pain and continence). Median follow-up was 41.4months [0.9-138.8]. SUI recurrence or de novo UUI occurred in 52 cases (58.4%): 19 (51.3%) patients in the TVT group, 31 (62%) in the TOT group, and both patients (100%) who underwent total removal of both slings. Among patients with SUI recurrence or de novo UUI, 39 (75%) had pain relief after sling removal. Seventeen patients (32.6%) refused any treatment, 14 (26.9%) were cured with conservative therapy, and 21 (40.3%) underwent SUI or UUI surgery. One patient had de novo pelvic pain after reoperation. The overall continence rate for all patients who underwent sling revision was 82% (73 out of 89) at the last follow-up. After MUS revision for CPP, post-operative UI may occur in 58.4% of patients, of which, one-fourth may be managed with conservative measures only. Forty percent of them had redo surgery with a low risk of pain recurrence and a high rate of urinary continence.

The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country.

Objectives:To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI).Methods:We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6).Results:Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure.Conclusions:All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI.

Quality of life and sexual function after TVT surgery versus Bulkamid injection for primary stress urinary incontinence: 1\xa0year results from a randomized clinical trial

Introduction and hypothesisTo assess changes in quality of life (QoL) and sexual function outcomes at 1 year after tension-free vaginal tape (TVT) versus polyacrylamide hydrogel injection (PAHG).MethodsIn a randomized trial comparing TVT (n = 111) and PAHG (n = 113) treatments of stress urinary incontinence (SUI), we compared urinary incontinence and health-related QoL using the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire, Short Form (IIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and RAND-36 Item Health Survey (RAND-36) at baseline and 1 year.ResultsUDI-6 and IIQ-7 showed improved incontinence-related QoL (p = 0.001) from baseline in both groups except for difficulty emptying the bladder and pain/discomfort. At 1 year, TVT patients experienced less urinary symptom-related distress compared to PAHG (p < 0.001). Sexual function improved in both groups (p < 0.001 for TVT and p = 0.01 for PAHG) with higher scores for the physical section subscale (p < 0.001) for TVT. Health-related QoL (RAND-36) improved from baseline in both groups in physical and social functioning (p < 0.001) with better outcome in the TVT group for physical functioning (p < 0.001). Increase in pain from baseline (p = 0.02) was detected for TVT, but not for PAHG. However, there was no difference between the groups (p = 0.78).ConclusionsIn primary SUI, TVT and PAHG treatments both improved QoL and sexual function at 1 year. However, incontinence and health-related QoL scores were better in the TVT group. More pain compared to the baseline was reported after TVT, although there was no difference between groups. Clinical significance needs to be evaluated in long-term follow-up.

Single-incision mini-sling for the treatment of female stress urinary incontinence: Is it actually inferior to transobturator vaginal tape and tension-free vaginal tape?

Objectives:The aim of the study was to report the extended long-term results of the use of single-incision mini-sling (SIMS), tension-free vaginal tape (TVT), and transobturator tape (TOT) for the treatment of female stress urinary incontinence (SUI) at the Department of Gynecology and Obstetrics of the University Medical Center Ljubljana.Materials and Methods:Enrolled women were evaluated by Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), Sandvik severity scale, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) Short Form and data about diagnosis, procedures, complications, reoperations, postoperative results, and satisfaction with procedure were recorded.Results:In analyzed group of patients (n = 357), 116 (32%) underwent SIMS procedure, 189 (53%) TOT, and 52 (15%) TVT. The SIMS, TOT, and TVT groups did not differ significantly from each other in PGI-S, PGI-I, Sandvik severity scale, UDI-6, IIQ-7, and ICIQ-UI Short Form or in postoperative complication rate. Repeat surgery was needed in 9.5% after SIMS, in 13.2% of TOT patients and in 23.1% of TVT patients (P = 0.194). Urinary retention occurred in 9.5% of the SIMS patients, in 9.5% of the TOT patients, and in 13.5% of the TVT patients (P = 0.682). Mesh erosion/inflammation occurred in 3.4% of the SIMS patients, in 6.3% of the TOT patients, and in 3.8% of the TVT patients (P = 0.485).Conclusion:The efficacy and safety of SIMS, TOT, and TVT in the surgical treatment of SUI are comparable. The choice of the technique should be based on the relative pros and cons of techniques and the surgeon's experience.

Impact of age on outcomes of midurethral sling procedures in women.

Trans-obturator tape (TOT) and tension-free vaginal tape (TVT) comprise minimally invasive surgical management for stress urinary incontinence (SUI). The aim of this retrospective cohort study was to investigate outcomes of TOT and TVT among different age groups of women. Medical records of patients who underwent TOT and TVT from January 2010 to December 2015 were reviewed. Patients were stratified into three groups according to age. All patients were interviewed routinely before and after surgery. The primary outcome was cure rate after surgery. Secondary outcomes included hospital stay, operative time, blood loss in surgery, and complication rate. A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. There were 81 patients in group 1 (≤ 50years), 97 patients in group 2 (51-59years), and 84 patients in group 3 (≥ 60years). After surgery, there were no significant differences in cure rates among the three groups (96.3% vs. 94.8% vs. 97.6%, P = 0.623). There were also no significant differences in operation time, blood loss, hospital stay, and complication rate among the three groups. When analyzing the TOT group (217 patients) and TVT group (45 patients) separately, primary and secondary outcomes did not differ significantly according to age group. As surgical management for SUI, midurethral sling procedures, both TOT and TVT, were found to be safe and effective among different age groups.

Efficacy of the trans‑obturator and retropubic mid‑urethral slings for stress urinary incontinence

Background: The aim of our study was to report the extended long-term results of the use of tension-free vaginal tape (TVT) and trans-obturator tape (TOT) for the treatment of female urinary stress incontinence (SUI) at the Division of Gynaecology and Obstetrics / UMC Ljubljana. There are few data on this topic in the literature. Our aim was to find out whether and how the procedure improved the patients’ quality of life and for how long, whether the patients had complications after the procedure, and how this type of procedure affected the long-term results.Methods: A retrospective clinical trial comparing the use of TVT and TOT was carried out from January to August 2017 and included all the patients operated on at the Division of Gynaecology and Obstetrics / UMC Ljubljana with TVT or TOT procedure for stress or mixed urinary incontinence (UI) associated with urethral hyper mobility (the stress component was clinically predominant). The exclusion criteria were more than 10 years from procedure, age more than 80 years in 2016, previous anti-incontinence surgery and/or pelvic organ prolapse more than stage I on POP–q in any vaginal compartment. After inclusion and exclusion criteria, 1104 patients were sent quality-of-life questionnaires (PGI-S, PGI-I, SANDVIK SEVERITY SCALE, UDI-6, IIQ-7, ICIQ-UI Short Form (Slovenian)) with questions about the diagnosis, procedures, complications, reoperations, post-operative results, and satisfaction with the procedure. Till August 2017 (6 months after sending) we received 466 questionnaires (42.2 % response rate). After 225 questionnaires were excluded due to incomplete data, 241 questionnaires were analysed.Results: In the analysed group of patients (N = 241), 189 (78 %) had TOT and 52 (22 %) had TVT. Our retrospective study has confirmed that the efficacy and safety of TOT and TVT in the surgical treatment of SUI are comparable. The TOT and TVT groups did not differ significantly from each other in PGI-S, PGI-I, SANDVIK SEVERITY SCALE, UDI-6, IIQ-7, and ICIQ-UI Short Form or in postoperative complication rate. Repeat surgery was needed in 25/189 (13.2 %) TOT patients and 12/52 (23.1 %) TVT patients; p = 0.082. Urinary retention appeared in 18/189 (9.5 %) TOT patients and 7/52 (13.5 %) TVT patients; p = 0.411. Mesh erosion/inflammation appeared in 12/189 (6.3 %) TOT patients and 2/52 (38 %) TVT patients; p = 0495.Conclusion: We can conclude that the efficacy and safety of TOT and TVT in the surgical treatment of SUI are comparable. The choice of the technique should be based on the relative pros and cons of techniques and the surgeon’s experience.

Effectiveness and Complications of TVT and TVT - O Operations in the Treatment of Female Stress Urinary Incontinence. Five Years Follow - Up Prospective Study

The Aim of the Study: To compare TVT (tension - free vaginal tape) and TVT - O (tension - free vaginal tape obturator) operations: results, complications, effectiveness after 5 years of follow - up. Material and M ethods: A single center nonblind, prospective study of women with SUI who were randomized to TVT and TVT - O from April 2005 to April 2013. Prospective study out of 394 patients, 114 were operated using TVT operation and 280 patients – TVT - O operation. There was no significant difference between groups concerning the age, BMI (body mass index), parity, menopausal status and prolapse (no patients had cystocele greater than stage II). Results: Mean operat ive time was significantly shorter in the TVT - O group (18±4.6 min) compared with the TVT group (27±7.1 min). There were no significant differences in the effectiveness of both procedures after 5 years. Hospital stay was statistically significantly shorter in TVT - O group (1.2±0.5 days) than in TVT group (4.0±0.6 days). Significantly less complication were in TVT - O group. Conclusion: TVT and TVT - O operations are equally effective for the surgical treatment of female stress urinary incontinence. TVT - O had a sh orter operation time and a lower complication rate.

TVT versus TOT in the treatment of female stress urinary incontinence: a systematic review and meta-analysis.

BackgroundTo evaluate the evidence available on the effects and safety of tension-free vaginal tape (TVT) versus transobturator tape (TOT) for female stress urinary incontinence therapy based on randomized controlled trials (RCTs).MethodsPubMed, Cochrane, Embase, Wanfang, China National Knowledge Infrastructure, and Weipu database were searched up to July 2017 to identify relevant studies, including qualified RCT and quite-RCT and literature sources. Relative risks (RRs), mean difference (MD), and 95% CI were calculated in our review.ResultTwenty-eight RCTs were involved in the meta-analysis with 2,505 patients in the TVT group and 2,477 patients in the TOT group. The aggregated results indicated that TOT significantly decreased the operative time (MD, −1.27; 95% CI: −1.77 to −0.76) and hospital stay (MD, −0.62; 95% CI: −1.08 to −0.17) when compared with TVT. Besides, the complications (RR, 0.86; 95% CI: 0.64–1.16) and blood loss (MD, −0.29; 95% CI: −0.71 to 0.14) were decreased in TOT but with no statistical significance; the change of VAS score (MD, 0.07; 95% CI: −0.05 to 0.19), IIQ-7 score (MD, 0.06; 95% CI: −0.03 to 0.15), and UDI-6 score (MD, 0.15; 95% CI: −0.19 to 0.48) were larger in TOT group than in TVT group, but still, with no statistical significance. However, there was no significant difference of cure rate (RR, 1.00; 95% CI: 0.96–1.04) and satisfied rate (RR, 1.00; 95% CI: 0.96–1.04) between the 2 groups.ConclusionTOT may have more valid effects than TVT in operative time and hospital stay. Besides, TOT method showed fewer complications and blood loss than TVT, but there was no significant difference between them. The scores of VAS, incontinence impact questionnaire short form-7 (IIQ-7), and urogenital distress inventory short form-6 (UDI-6) were higher in TOT than TVT, but still no significant difference was observed. However, more studies with higher quality and larger sample size that are multicentric and have longer follow-up in the form of RCTs are warranted to confirm the current findings.

Comparison between erbium-doped yttrium aluminum garnet laser therapy and sling procedures in the treatment of stress and mixed urinary incontinence

PurposeStress urinary incontinence (SUI) and mixed urinary incontinence (MUI) lead to poor quality of life. In Japan, urinary incontinence is treated with tension-free vaginal tape (TVT) or transobturator tape (TOT) sling procedures, which involves inserting a synthetic material; however, problems arise with artificial mesh in some instances, requiring new treatment methods. Hence, laser therapy, whereby an erbium-doped yttrium aluminum garnet laser is directed into the vagina and urethra, may be useful. The study aimed to compare the effects of these three treatments.MethodsSubjects included patients who received TVT, TOT, or laser therapy (n = 50 each). The 1-h pad test, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and overactive bladder symptom score were used to assess the patients before and 12 months after treatment. For laser therapy, a probe was inserted into the vagina after applying a local anesthetic to the vaginal wall, and irradiation was performed for 20 min at a wavelength of 2940 nm. This treatment was performed three times every alternate month.ResultsAs per the 1-h pad test and ICIQ-SF, the TVT, TOT, and laser therapy groups showed comparable improvements in SUI. For patients with MUI, some in the TVT and TOT groups showed exacerbation; however, all patients in the laser therapy group tended to improve.ConclusionsThe efficacy of laser therapy for urinary incontinence was confirmed. This is the first study to report on the effect of laser therapy on urinary incontinence in Japanese women.

Comparison between tension-free vaginal tape and transobturator tape in treating stress urinary incontinence after vaginal mesh surgery

ObjectiveA midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients. Materials and MethodsWe enrolled patients who had symptomatic SUI after anterior vaginal mesh repair who underwent either TVT or TOT surgery. Successfully cure was defined as the absence of urinary leakage in a stress test during filling cystometry, and a negative cough test. Quality of life was evaluated using the short form of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). ResultsWe included 50 patients in the TOT group and 37 patients in the TVT group, with a median follow-up of 18.5 months. The TVT group had a significantly higher success rate than the TOT group (88% vs. 60%, p = 0.036), while there was no statistically significant difference in de novo detrusor overactivity (30% vs. 9%, p = 0.090). There was also no significant difference in postoperative quality of life (UDI-6, 5.9 ± 7.9 vs. 5.0 ± 5.9, p = 0.639; IIQ-7, 5.2 ± 12.5 vs. 4.3 ± 9.7, p = 0.766). The TVT group had a longer operative time (p < 0.001) and hospital stay (p = 0.004), however the TOT group required more repeat surgeries for recurrent SUI (p = 0.045). ConclusionRetropubic TVT is a more effective surgical option than TOT in women with SUI after vaginal mesh repair.

The long-term effectiveness analysis of retropubic and transobturator tension-free vaginal tape in the treatment of female stress urinary incontinence

Objective To compare the long-term outcomes of the retropubic tension-free vaginal tape (TVT) versus the transobturator tension-free vaginal tape (TVT-O) for women with stress urinary incontinence (SUI). Methods From July 2001 to June 2011, data of 120 female patients with SUI were retrospectively reviewed, of which 45 patients received TVT treatment, while 75 patients received TVT-O. The median age in TVT group was 45.1 years (range 35-72 years), and the median age in TVT-O group was 50.5 years (range 39-76 years). We retrospectively analyzed the long-term subjective effect, objective effect and the rate of complications in the two groups. Results Median follow-up period was 121 months (range 72-192 months). The complete satisfaction rate was 89%(40/45) in TVT group, and 92%(69/75) in TVT-O group, with no statistical difference between the two groups. The negative rate of cough test was 84.4%(38/45) in TVT group, and 76.0%(57/75)in TVT-O group, with a statistically significant difference. The rate of urinary tract injury was 8.9% (4/45)in TVT group, and 4.0%(3/75) in TVT-O group. The rate of thigh pain was 0 in TVT group, and 6.7%(3/45) in TVT-O group. The rate of micturition frequency and urinary incomplete emptying after operations was 6.7%(5/75) in TVT group, and 5.3%(4/75) in TVT-O group. Conclusions The long-term subjective effect between TVT and TVT-O groups was similar. The objective effect in TVT group was better. There was no statistical difference in complication rate between the two groups, which showed different types of complications in different procedures. Key words: Stress urinary incontinence(SUI); Tension-free vaginal tape(TVT); Transobturator vaginal tape(TVT-O); Long-term effect

An in-house Composix™-based pubovaginal sling trial for female stress urinary incontinence: Five-year comparative followup to tension-free and transobturator vaginal tapes.

We compared the efficacy of three slings in the long-term treatment of stress urinary incontinence (SUI): tension-free vaginal tape (TVT), vaginal tape-obturator (TVT-O), and an in-house two-layered polypropylene mesh with a submicronic polytetrafluoroethylene (Composix™). Our primary endpoint was the objective measurement of continence (24-hour pad test). Secondarily, we measured the satisfaction and complication rates. This prospective, non-randomized study included 128 patients with SUI. Preoperative evaluation included medical history, physical exam, 24-hour pad test, Urinary Incontinence Quality of Life Scale (IQOL), FPSUND, and global satisfaction questionnaires. Patients were followed at one month postoperative, biannually for two years, and then annually for a total of five years. Followup visits included a focused questionnaire, physical exam, satisfaction questionnaire, 24-hour pad test, IQOL, and FPSUND questionnaires. Composix, TVT, and TVT-O groups included 60, 34, and 34 patients, respectively. No significant differences were found in baseline characteristics except for the pad test. Length of catheterization was the only immediate operative significant parameter (Composix 4.7 days vs. TVT 1.1 days vs. TVT-O 2.6 days; p=0.03). The entire cohort had significant improvements in their IQOL, FPSUND, and pad test at one and four years (p<0.01). The cohort-wide 24-hour pad test average weight was 30.4 g preoperatively vs. 5 g at 12 months (p<0.00001) (Composix 37 to 5 g, TVT 83 to 4 g, and TVT-O 55 to 5 g). The Composix group had a higher number of minor complications (Clavien I, II) and secondary procedures. This single-surgeon cohort with five-year followup demonstrated a large improvement and maintenance of continence in all three surgical groups. The Composix-based sling provided comparable continence outcomes at a fraction of the cost; however, its increased morbidity and higher complication rate raise concerns over future use.

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.

Long-term efficacy of the trans-obturator and retropubic mid-urethral slings for stress urinary incontinence: update from a randomized clinical trial.

To report the extended long-term results of the use of tension-free vaginal tape(TVT) and trans-obturator tape (TOT) for the treatment of female stress urinary incontinence (SUI). A prospective, multicentre randomized clinical trial comparing the use of TVT and TOT was used to evaluate 87 patients. The inclusion criteria were stress or mixed UI associated with urethral hyper mobility (the stress component was clinically predominant), while the exclusion criteria were previous anti-incontinence surgery and/or pelvic organ prolapse. The objective cure criteria were a negative provocative stress test and a negative 1-h pad test, with no further treatment for SUI. The subjective cure criteria were a 3-day voiding diary, quality-of-life questionnaires (UDI6-IIQ7), and patient satisfaction on a scale from 0 to 10. Eighty-seven patients were evaluated (47 TOT and 40 TVT) at a median follow-up of 100 months. Subjective and objective cure rates were 59.6 and 70.2 % in the TOT group and 75 and 87.5 % in the TVT group. The mid-to-long-term trend was a decreasing continence rate in patients who underwent TOT, compared with a stable rate for TVT. The Kaplan-Meier survival curve showed that continence rate decreased for up to 25 months after surgery, with stabilization thereafter for the TVT group while continuing to drop in the TOT group, with no inter-group difference. The patients in both groups were highly satisfied at long-term follow-up. The overall continence rate worsened for both groups within 25 months. While the results tend to stabilize in the TVT group, a further decline in the TOT was observed.