Tension-free Vaginal Tape For Treatment Research Articles

Tension-free vaginal tape for treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects at 17-year follow-up.

To assess the efficacy and safety of retropubic tension-free vaginal tape (TVT) 17years after implantation for the treatment of female pure stress urinary incontinence (SUI). A prospective study was conducted in two urogynaecological units in two countries. All consecutive women with urodynamically proven pure SUI treated by TVT were included. Patients with mixed incontinence and/or anatomical evidence of pelvic organ prolapse were excluded. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement, and patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable analysis was performed to investigate outcomes. A total of 52 women underwent TVT implantation. At 17-year follow-up, 46 women (88.4%) were available for the evaluation. We did not find any significant change in surgical outcomes during this time. At 17years after surgery, 41 of 46 women (89.1%) declared themselves cured (P = 0.98). Similarly, at 17-year evaluation, 42 of 46 women (91.4%) were objectively cured. No significant deterioration in objective cure rates was observed over time (P for trend 0.50). The univariate analysis did not find any risk factor statistically associated with the recurrence of SUI. Of the 46 women, 15 (32.6%) reported the onset of de novo overactive bladder at 17-year follow-up. No other late complications were reported. The 17-year results of this study showed that TVT is a highly effective and safe option for the treatment of SUI.

Surgical treatment of stress urinary incontinence–trans‐obturator tape compared with tension‐free vaginal tape–5‐year follow up: an economic evaluation

To conduct an economic evaluation of the use of trans-obturator tape (TOT) compared with tension-free vaginal tape (TVT) in the surgical treatment of stress urinary incontinence in women. Cost-utility and cost-effectiveness analyses from a public-payer perspective, conducted alongside a randomised clinical trial. Health services provided in Alberta, Canada. A total of 195 women participated in the randomised clinical trial, followed to 5 years postsurgery. Comparisons were undertaken between study groups for cost and two health-outcome measures. Multiple imputation was used to estimate the 14% of missing data. Bootstrapping was used to account for sampling uncertainty. Sensitivity analyses were based on complete case analyses and the removal of a TVT patient with extreme health service cost. The 15D instrument was used to calculate quality-adjusted life-years (QALYs) for the primary analysis. Absence of serious adverse events was also analysed. Costs were based on inpatient and outpatient hospital use data and practitioner fee-for-service claims data. The TOT group had a nonsignificant average saving of $2368 (95% CI -$7166 to $2548) and incremental gain of 0.04 QALYs (95% CI -0.06 to 0.14) compared with TVT. TOT was dominant in over 71% of bootstrap replications and cost-effective over a wide range of willingness-to-pay. Cost-effectiveness analysis using the absence of an serious adverse events provided similar results. The results suggest that TOT is cost-effective compared with TVT in the treatment of stress urinary incontinence. The results of a 5-year cost-effectiveness analysis suggest that trans-obturator tape is cost-effective compared with tension-free vaginal tape in the treatment of stress urinary incontinence.

Tension-Free Vaginal Tape versus Secure Tension-Free Vaginal Tape in Treatment of Female Stress Urinary Incontinence

Objective: To study the safety and efficacy of both tensionfree vaginal tape (TVT) and secure tension-free vaginal tape (TVT secur) in treatment of female stress urinary incontinence. Patients and Methods: Sixty female patients diagnosed as stress urinary incontinence were evaluated in the urogynecology clinic of the Benha Faculty of Medicine. All patients completed the impact of Incontinence on Quality of Life Questionnaire. They were randomly divided into 2 equal groups: group I (n = 30) underwent TVT procedure and group II (n = 30) underwent TVT secur procedure. The 2 techniques were compared regarding operative time, intraoperative bleeding, duration of catheterization, intra- and post-operative complications and hospital stay. All patients were followed up for 9 months and subjected to evaluation by history, examination, and urodynamics pre- and post-operatively. Results: Operative time and intra-operative morbidity were significantly lower in the TVT secur group than in the TVT group. No significant difference could be detected regarding catheterization period and success rate. The cure rate was 90.1% in group I and 93.4% in group II and this difference was statistically insignificant. Patients with a Valsalva leak point pressure lower than 60 cm H2O had poor outcome in both groups. Conclusion: TVT secur could be considered as a safe, easy and effective alternative to TVT with less morbidity.

Effects of laparoscopic Burch colposuspension and tension-free vaginal tape in treatment of female stress urinary incontinence: a comparative study

To evaluate the efficacy and complications of laparoscopic Burch colposuspension and tension-free vaginal tape (TVT) in treatment of female stress urinary incontinence (SUI). Thirty patients underwent laparoscopic Burch colposuspension and 67 age, BMI, parity, and grading-matched patients underwent TVT because of moderate to severe hypermotility urodynamic SUI from 2002 to 2006. Follow-up was conducted for (9 +/- 10) months. The clinical characteristics, mean operation time, hospital stay, peri-operative complications, and late complications were compared. The mean operative time and the hospital stay of the TVT group was (29.57 +/- 8.23) min and (3.0 +/- 2.1) d, both significantly shorter than those of the Burch operation group [(87 +/- 23) min and (4.8 +/- 1.9) d respectively, P < 0.001 and P < 0.01]. The blood loss of the TVT group was (27 +/- 12) ml, significantly less than that of the Burch operation group [(59 +/- 30) ml, P < 0.001]. The subjective cure rate of the Burch operation group was 86.5%, not significantly different from that of the TVT group (95.5%, P > 0.05). Short-term complications included 1 case of bladder injury and 1 case of circumflex iliac vein injuring, both occurring in the Burch colposuspension group. The postoperative urine retention rate of the Burch colposuspension group was 23.5%, not significantly different from that of the TVT group (14.9%, P > 0.05), and the postoperative fever rate of the Burch colposuspension group was 16.2%, significantly higher than that of the TVT group (4.5%, P < 0.05). Three cases of erosion of sling were found in the TVT group as late complications. Both Burch colposuspension and TVT are effective in the treatment of female SUI. The mean operative time of Burch operation and the hospital stay thereafter are longer; however, the cost of TVT is much higher than that of the Burch operation.

Transobturator tape procedure versus tension-free vaginal tape for treatment of stress urinary incontinence

Objective To compare the efficacy and safety of the tension-free vaginal tape (TVT) and inside-out transobturator tape (TVT-O) procedures for the treatment of stress urinary incontinence (SUI). Methods A total of 315 women with or without concomitant pelvic organ prolapse repairs were randomly allocated to undergo a TVT or TVT-O procedure. Demographic data, intra- and postoperative complications, and surgical outcomes were analyzed. Results Fifteen patients were lost to follow-up. There were no significant differences in cure rates between the 2 groups at 6, 12, 24, and 36 months' follow-up. Hematomas occurred in 4 patients and there were 6 vaginal tape erosions. Urinary retention and de novo urinary urgency were similar in both groups. The operative time was significantly shorter for TVT-O than for TVT without other procedures ( P < 0.001) and postoperative groin/thigh pain was higher ( P < 0.05) in the TVT-O group. Conclusion Both techniques appear equally effective for the treatment of SUI. However, TVT-O had a shorter operative time and a higher rate of groin/thigh pain.

Cecal perforation complicating placement of a transvaginal tension-free vaginal tape

The tension-free vaginal tape has been increasingly used to treat stress urinary incontinence. This procedure has a high success rate and unique surgical complications. The patient is a 39-year-old with genuine stress urinary incontinence and underwent placement of tension-free vaginal tape for treatment. Twelve hours after the procedure, the patient had increasing abdominal pain, and an acute abdominal series showed free intraperitoneal air. Exploratory laparotomy revealed stool in the peritoneal cavity, with the vaginal tape placed through the cecum. Bowel complications are rare; however, they may occur and should be suspected in a patient with an acute abdomen and free air.

The Long-Term Results of Pubovaginal Sling Surgery Using Acellular Cross-Linked Porcine Dermis in the Treatment of Urodynamic Stress Incontinence

Acellular cross-linked porcine dermis is a potential substitute for rectus fascia as a sling material with the advantage of decreased morbidity. However, the long-term efficacy is unknown. We compared the 3-year efficacy of PD vs autologous rectus fascia as a sling material for pubovaginal sling surgery in the treatment of urodynamic stress incontinence. Between July 2000 and December 2001 a total of 101 consecutive, nonrandomized patients with USI underwent a PD (51) or RF (50) sling procedure. Patients were assessed at 6 weeks, and at 3, 6 and 12 months postoperatively. Urodynamic study was repeated in cases of treatment failure. A detailed survey questionnaire was mailed to all patients at least 36 months after surgery and all responders were then retested by telephone interview by a blinded assessor. The primary outcome measure was patient perceived success rate (cured or improved) at least 36 months after PVS. Secondary outcome measures were patient satisfaction 36 months after surgery, durability of success with time and reoperation rate. Complete data were available on 94 patients (48 treated with PD and 46 treated with RF sling). The groups were well matched for age, leak point pressure, prior incontinence surgery and urge symptoms. Pubovaginal sling was successful (cured or improved) in 37 (80.4%) patients treated with RF but in only 26 (54%) patients treated with PD 36 months after surgery (Fisher's exact test p = 0.009; 95% CI 8.03, 44.4). Treatment failure occurred by 9 months after RF and by 24 months after PD sling procedure. Repeat urodynamic study showed USI to be the cause of treatment failure in 18 (37.5%) of 20 patients treated with PD but in only 3 (6.5%) of 8 patients treated with RF. We have shown that use of the PD sling, although reducing early morbidity, results in a significantly inferior long-term cure rate in comparison to the RF sling. Therefore, acellular cross-linked porcine dermis should not be used as a substitute for rectus fascia.

Pelvicol™ Pubovaginal Sling Versus Tension-Free Vaginal Tape for Treatment of Urodynamic Stress Incontinence: A Prospective Randomized Three-Year Follow-up Study

Pelvicol™ Pubovaginal Sling Versus Tension-Free Vaginal Tape for Treatment of Urodynamic Stress Incontinence: A Prospective Randomized Three-Year Follow-up Study

Pelvicol™ Pubovaginal Sling versus Tension-Free Vaginal Tape for Treatment of Urodynamic Stress Incontinence:A Prospective Randomized Three-Year Follow-Up Study

Pelvicol™ Pubovaginal Sling versus Tension-Free Vaginal Tape for Treatment of Urodynamic Stress Incontinence:A Prospective Randomized Three-Year Follow-Up Study

Concomitant vaginal surgery with tension-free vaginal tape for treatment of female stress urinary incontinence and pelvic prolapse

Concomitant vaginal surgery with tension-free vaginal tape for treatment of female stress urinary incontinence and pelvic prolapse

Objective and subjective cure rates after tension-free vaginal tape for treatment of urinary incontinence

Objectives. To assess the objective and subjective cure rates after the tension-free vaginal tape (TVT) procedure in women with urinary incontinence. Methods. We performed a retrospective analysis of 112 consecutive women with genuine stress (n = 88) and mixed (n = 24) incontinence. The objective cure rate was evaluated by clinical and urodynamic examinations and the subjective cure rate using the Contilife questionnaire. The mean follow-up time was 25 months (range 18 to 34). Results. The mean operative time was 30 minutes (range 25 to 50). Most patients (58%) underwent surgery with locoregional anesthesia. The overall complication rate was 37.5% (42 of 112). The perioperative complication rate was 14.3%, including 13 bladder injuries (11.6%). Five (38.5%) of the latter occurred in 7 patients with a previous history of incontinence surgery ( P <0.001). The early postoperative complication rate was 32.1%. The main complication was voiding difficulties, diagnosed in 14 patients. Ten (71.4%) required intermittent self-catheterization for less than 15 days and four for a mean duration of 28 days (range 15 to 90). The late postoperative complication rate was 29.4%, including 29 cases of de novo urge symptoms (25.9%). Anticholinergic drugs were effective in only 15 (51.7%) of the 29. The objective cure rate was 89.3%. No difference was found between patients with genuine stress incontinence and those with mixed incontinence. The subjective cure rate was 66%. The difference in cure rates between the objective and subjective evaluations was significant ( P <0.05). The subjective cure rate in patients with de novo urge symptoms was 37.9%. Conclusions. Our results demonstrate that the TVT procedure is a safe and effective surgical method. The lower subjective cure rate was related to the high incidence of de novo urge symptoms.