Tension-free Vaginal Tape In Patients Research Articles

Tension-Free Vaginal Tape Failure After Robotic Sacrocolpopexy and Tension-Free Vaginal Tape for Concomitant Prolapse and Stress Incontinence.

Evidence of surgical cure with tension free vaginal tape (TVT) is robust for isolated stress urinary incontinence, but rigorous studies investigating combined prolapse and incontinence are lacking. Our study measured cure of stress incontinence in concomitant robotic sacrocolpopexy and retropubic sling (TVT). We hypothesized a higher rate of objective failure as measured by the cough stress test (CST) compared to failures reported in recent randomized trials of TVT in patients without prolapse (aggregate 8% failure). Prospective cohort of patients with stress incontinence and prolapse, scheduled for robotic sacrocolpopexy and TVT. Outcomes assessed at 12 months: CST (primary aim), Patient Global Impression of Improvement (PGI-I), Pelvic Floor Distress Inventory, and the Sandvik questionnaire. Sixty-six of 77 subjects (86%) completed follow-up. Average age was 65 years, 96% were white, with mean body mass index of 28.1 kg/m2. Mean parity was 2.7, 50% had a previous hysterectomy. Mean leading edge of prolapse was +2.3 cm. All patients underwent the planned surgery; additionally, 50% underwent hysterectomy and 38% posterior colporrhaphy.The TVT failure (+CST) was 19.7% (95% confidence interval, 11.3%-31.7%; P < 0.001 compared to 8%). Neither preoperative disease severity, nor preoperative prolapse stage affected risk of failure of TVT. Eighty-three percent of the subjects were happy or very happy (PGI-I). However, those with a positive CST (failure) had significantly less satisfaction on PGI-I, UDI-6, and Pelvic Floor Distress Inventory-20. In this population with advanced prolapse, cure of stress urinary incontinence by TVT in setting of robotic sacrocolpopexy is lower compared to published trials where prolapse is absent. Women are less satisfied when the postoperative CST is positive.

Outcome of midurethral tape continence surgery in patients with and without urodynamically confirmed stress incontinence

To compare the outcomes of midurethral tape continence surgery in patients with urodynamically confirmed stress incontinence (USI) and patients with symptoms of stress urinary incontinence but normal urodynamic studies (NUDS) and a positive 1-h pad test. Analysis of data collected prospectively from 356 women who underwent tension-free vaginal tape (TVT) surgery from June 1998 to September 2009. There were 25 women with NUDS but a positive pad test. Outcome measures in these 25 women were compared with 65 women with urodynamically confirmed stress incontinence. These 65 women were chosen as suitable controls from the group of 331 potential controls. All the women underwent TVT surgery under local or spinal anaesthesia. The outcome measures were: (1) absence of stress urinary incontinence symptoms, (2) new occurrence of lower urinary tract irritative symptoms (LUTS), (3) persistent voiding dysfunction (VD), and (4) recurrent urinary tract infections (UTIs). Following TVT, stress incontinence was absent in 100% and 97% of patients in the NUDS and USI groups respectively. The occurrence of LUTS was 4% and 4.6% in the NUDS and USI groups, while VD was found in 4% and 4.6% and recurrent UTIs in 8% and 6.1% of the groups respectively. There were no significant differences in outcomes following TVT in patients with and without urodynamically confirmed stress urinary incontinence.

Effectiveness of Tension-Free Vaginal Tape in Patients with Stress Urinary Incontinence and Intrinsic Sphincter Deficiency: A Retrospective Review

Effectiveness of Tension-Free Vaginal Tape in Patients with Stress Urinary Incontinence and Intrinsic Sphincter Deficiency: A Retrospective Review

Pre‐operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre‐operative mixed urinary incontinence

To determine if specific pre-operative urodynamic parameters could predict detrusor overactivity following TVT in patients with urodynamic mixed incontinence. Notes of women with detrusor overactivity (DO) and urodynamic stress incontinence (USI) before undergoing tension-free vaginal tape (TVT) surgery were retrospectively reviewed. Patients underwent clinical evaluation pre-operatively including history, examination, and conventional urodynamic studies and were treated with pelvic floor exercises and anti-cholinergic medication. Those with persistent stress urinary incontinence (SUI) underwent TVT. Patients were re-assessed after at least 6 months post-operatively. Pre- and post-operative opening and closing detrusor pressure, and detrusor pressure at maximum flow were recorded retrospectively from pre-operative urodynamics traces by two clinicians independently and compared to the patients' post-operative symptoms and urodynamic diagnosis. Fifty-one women were reviewed. Forty-six of the 51 attended follow-up and 35/51 agreed to conventional urodynamic studies. Seventeen of the 35 reported OAB symptoms, and 18/35 were asymptomatic. Nineteen of the 35 women had DO and 16/35 had normal urodynamic studies (NUDS). The median pre-operative opening detrusor pressure was higher in women with overactive bladder symptoms post-operatively. The median pre-operative opening detrusor pressure in women with DO post-operatively was 33.0 cmH(2)O and the median pre-operative opening detrusor pressure in those with NUDS post-operatively was 16 cmH(2)O (15.0-23.0 cmH(2)O) (P < 0.05 Mann-Whitney U-test). Higher numbers of patients are required to demonstrate the value of opening detrusor pressure in predicting post-operative overactive bladder symptoms. Opening detrusor pressure is predictive of post-operative DO after TVT.

Is transobturator tape as effective as tension-free vaginal tape in patients with borderline maximum urethral closure pressure?

The purpose of this study was to compare transobturator tape (MONARC) with tension-free vaginal tape in patients with borderline low maximum urethral closure pressure. Historical cohort analysis of 3-month outcomes in 145 subjects (MONARC = 85; tension-free vaginal tape = 60). A cut-off point of 42 cm H2O for preoperative maximum urethral closure pressure was identified as predictor of success in the entire cohort. The cohort was stratified by sling type and analyzed. Outcome variables included urodynamic stress incontinence, urethral pressure profiles, subjective stress incontinence symptoms, and complications. The relative risk of postoperative urodynamic stress incontinence 3 months after surgery in patients with a preoperative maximum urethral closure pressure of 42 cm or less H2O was 5.89 (1.02 to 33.90, 95% confidence interval) when we compared MONARC with tension-free vaginal tape. Subjects in the MONARC and tension-free vaginal tape groups did not differ significantly in baseline characteristics. We defined subjects as failures if they demonstrated postoperative objective stress incontinence on multichannel urodynamic testing. In subjects with maximum urethral closure pressure of 42 cm or less H2O, the MONARC was nearly 6 times more likely to fail than tension-free vaginal tape at 3 months after surgery. Long-term follow-up and randomized controlled trials are needed.

Result of the tension-free vaginal tape in patients with concomitant prolapse surgery: a 2-year follow-up study. An analysis from the Netherlands TVT database

This study assessed the long-term outcome of tension-free vaginal tape (TVT) in women with concomitant pelvic surgery. A prospective cohort study of 746 patients in 41 hospitals was undertaken. The Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to measure the results of the TVT. Fifty-nine patients with concomitant prolapse surgery were compared with 687 women with TVT only. The decrease in IIQ/UDI mean scores were statistically significant in both groups after the TVT. The success rates of "no leakage at all" is comparable for both groups. This study, with 54 gynecologists and urologists participating, showed the long-term (2 years) success rates of TVT with concomitant prolapse surgery. It shows that the procedure in conjunction with prolapse surgery can be safely performed with good results.

ORAL PRESENTATION 8: Is Trans-Obturator Tape as Effective as Tension-Free Vaginal Tape in Patients With a Borderline Maximal Urethral Closure Pressure?

ORAL PRESENTATION 8: Is Trans-Obturator Tape as Effective as Tension-Free Vaginal Tape in Patients With a Borderline Maximal Urethral Closure Pressure?

Tension-free vaginal tape (TVT) for treatment of stress urinary incontinence in women with low-pressure urethra

Objective:To assess the results of TVT in patients with urinary stress incontinence, urethral hypermobility, and low-pressure urethra. Study design:We retrospectively analysed 265 consecutive women who underwent a TVT procedure for urodynamic stress urinary incontinence over a 31-month period. Women were divided into two groups depending on their preoperative maximum urethral closure pressure (MUCP). Group 1 (61 women with MUCP ≤20cm H2O) were compared with 204 women (group 2) with a MUCP >20cm H2O. Subjective and objective outcome data were assessed from routine postoperative visits. Office and hospital records were reviewed to check patients’ characteristics, intraoperative findings, and surgical outcomes. Results:Women with low-pressure urethra were older than those with MUCP >20cm H2O; they were more likely to have had a hysterectomy or anti-incontinence surgery. The mean duration of follow-up was 31 (±11) months. Cure rates among patients with low- or normal-pressure urethra were similar (77% and 86%, P=0.70). Nevertheless, the former were more likely to complain of voiding dysfunction.Conclusion: TVT is a highly effective treatment even in women with intrinsic sphincter deficiency.

Results of tension-free vaginal tape in patients with or without LAVH

Objective. To assess complication and cure rate of tensionfree vaginal tape (TVT) procedure performed with or without LAVH. Desigrz. Retrospective comparison of 30 women with urinary incontinence treated by a TVT procedure alone and 50 combined with LAVH. Results. The two groups were similar in age, parity, menopausal status and type and sererity of incontinence. There no difference in overall complication rate. In the TVThysterectomy group, there was pc (p=0.04). The mean follow-up was similar: 12 and 15 months, respectively. No difference in objective and subjective cure rates was found between TVT group and TVT-LHVH group. Corzclusiorz. TVT is a safe and effective surgical treatment of urinary incontinence. The association of the procedure with LAVH gave similar short-term objective and subjective cure rates than TVT technique alone.

Results of tension-free vaginal tape in patients with or without vaginal hysterectomy

Objective: To assess complications and cure rates of tension-free vaginal tape (TVT) procedure performed with or without vaginal hysterectomy. Study design: Retrospective comparison of 41 women with urinary incontinence treated by a TVT procedure alone and 40 combined with vaginal hysterectomy. Objective cure was evaluated by clinical and urodynamic examination and by the contilife questionnaire. All patients were operated under regional anesthesia. Results: The two groups were similar in age, parity, menopausal status and type and severity of incontinence. There was no difference in overall complication rates. In the TVT-hysterectomy group, there was a trend towards more bladder perforation ( P=0.09). Post-operative urinary flow was lower in the TVT-hysterectomy group: 14 versus 24 ml/pc ( P=0.02). The mean follow-up was similar: 23 and 25 months, respectively. No difference in objective and subjective cure rates was found between TVT group and TVT-hysterectomy group: 97.6% versus 92.5% and 68.3% versus 75%, respectively. Conclusion: TVT is a safe and effective surgical treatment of urinary incontinence. The association of the procedure with vaginal hysterectomy gave similar short-term objective and subjective cure rates than TVT technique alone.