Tension-free Vaginal Tape Obturator Procedure Research Articles

Long-Term Outcomes of Tension-Free Vaginal Tape Obturator: Efficacy and Safety at Long-Term Follow-Up

Background/Objectives: The use of tension-free vaginal tape obturator (TVT-O) for the treatment of stress urinary incontinence (SUI) has been widely debated over the last decade due to the lack of evidence on its long-term outcomes. The aim of this prospective study is to assess, for the first time in the available literature, the efficacy and safety of TVT-O implantation in women with pure SUI over a 17-year follow-up period. Methods: We included all women who complained of pure SUI symptoms (confirmed urodynamically) and underwent the TVT-O procedure. An objective cure was defined as the absence of urine leakage during the stress test, while subjective outcomes were assessed by means of the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS). Results: A total of 70 patients who met the inclusion criteria underwent the TVT-O procedure. During the study period, no patients were lost to follow-up, and all women completed the last evaluation at the 17-year mark. At the 17-year mark of follow-up, 62 out of 70 patients (81.4%) were subjectively cured, and 56 out of 70 (80%) patients were objectively cured. These data do not reveal any significant variation in the surgical outcomes over the follow-up period. We recorded seven (10%) tape exposure (three occurred after 10 years and four after 17 years). Among these, one woman was symptomatic for dyspareunia and “hispareunia”. All patients with mesh exposure were treated with partial removal and re-suture of the vagina, but only one developed the recurrence of SUI that required a second treatment with a urethral bulking agent (UBA). In all other cases, women reported a complete resolution of symptoms without any worsening of the urinary continence. No significant bladder or urethral erosion was recorded. Conclusions: The 17-year evaluation of the TVT-O procedure has shown that it is a highly effective and safe option for the treatment of female SUI. Although there was an increased risk of tape exposure 17 years after implantation, no serious complications were reported, and no patient required the total removal of the sling.

PD14-12 SEXUAL FUNCTION IN WOMEN FOLLOWING TENSION-FREE VAGINAL TAPE-OBTURATOR PROCEDURE: A PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD14-12 SEXUAL FUNCTION IN WOMEN FOLLOWING TENSION-FREE VAGINAL TAPE-OBTURATOR PROCEDURE: A PROSPECTIVE STUDY Aymen Sakly, Walid Zakhama, Nejm Jleli, Aymen Mnasser, and Yassine Binous Aymen SaklyAymen Sakly More articles by this author , Walid ZakhamaWalid Zakhama More articles by this author , Nejm JleliNejm Jleli More articles by this author , Aymen MnasserAymen Mnasser More articles by this author , and Yassine BinousYassine Binous More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Midurethral tapes have shown favorable clinical outcomes for treating stress urinary incontinence (SUI). In the last decade, tension-free vaginal tape-obturator (TVT-O) lead to less complications with comparable results to conventional open surgeries and retropubic sling procedure. However, the effects of TVT-O on women’s sexual function are unclear. The aim of this study was to assess sexual function among women who underwent TVT-O for SUI. METHODS: From February 2018 to January 2022, we have enrolled a prospective study in which we recruited 63 women scheduled for correction of SUI by TVT-O procedure. Exclusion criteria were women without sexual activity, previous surgery for urinary incontinence or concomitant surgery for urogenital prolapse. Participants were required to complete the Female Sexual Function Index (FSFI) questionnaire. Preoperative and postoperative results were evaluated. Female sexual dysfunction was defined for a cutoff FSFI<26,55. The paired T-Student test was used to compare the scores. The significance level of p was set at 0,05. RESULTS: The mean age of our population was 64,4 years. Before surgery, the mean total FSFI score was 23.48±5.74. A female sexual dysfunction was observed in 68.2% of patients. The lowest score was attributed to desire, orgasm, and arousal items. Only 17 women (26,98%) have concomitant coital incontinence. Postoperatively, the mean resumption of sexual intercourses was at 2.7 months. The mean total FSFI score significantly increased to 28.617±5.21 (p<0.05). We found a significant improvement related to desire, satisfaction, and pain domains (p=0.03, p=0.01, p<0.001). In patients who had concomitant coital incontinence before surgery, the FSFI scores was higher than patients who did not have coital incontinence (1.67±1.84 vs. -0.13±2.15, p<0.05). CONCLUSIONS: TVT-O procedure provides significant improvement in the sexual lives of women. However, the patients who suffer from concomitant coital incontinence before the surgery will have a better sexual function improvement. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e417 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aymen Sakly More articles by this author Walid Zakhama More articles by this author Nejm Jleli More articles by this author Aymen Mnasser More articles by this author Yassine Binous More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexual function in women following tension-free vaginal tape-obturator procedure: A prospective study

Sexual function in women following tension-free vaginal tape-obturator procedure: A prospective study

Learning Curve for the Tension-Free Vaginal Tape-Obturator Procedure for Female Stress Urinary Incontinence: A Prospective Single-Surgeon Study.

Objective: To evaluate the learning curve in an untrained resident surgeon for the initial case series of tension-free vaginal tape-obturator (TVT-O) to treat stress urinary incontinence. Materials and Methods: A retrospective observational study was conducted in Changhai Hospital, Shanghai, China, between March 2014 and June 2018. All consecutive women included were treated by the TVT-O procedure performed by one surgeon working under the supervision of an expert surgeon. Clinical features, estimated blood loss, operative time, postoperative hospital stay, total hospital stay, adverse events, and subjective and objective cure rates were recorded. Learning curve patterns were estimated to determine the number of cases to reach a plateau using the moving average method. Results: In total, 188 patients were included for analysis. Patients ranged from 39 to 91 years, with the average age of 57.5 ± 9.7 years. The mean operative time was 32.0 minutes (range 20-60). Operative time and blood loss decreased with increase in the level of expertise, whereas postoperative hospital stay and total hospital stay were not influenced by the number of procedures performed. The number of cases required to reach a plateau was ∼30. Objective cure rate and subjective cure rate were achieved in 88.7% and 88.2% at 12 months, respectively. Groin pain was the most common postoperation complication, which continued to be present in 11.7% patients at 12 months after surgery. Conclusions: The TVT-O procedure showed encouraging objective and subjective outcomes and low complication rates, even at the initial stage of the learning curve. Thirty cases were required for a naïve resident surgeon to learn TVT-O procedures. However, long-term outcome and complications caused by the synthetic sling still need further follow-up.

Could the postoperative residual of urine predict the outcome of TVTOmidurethral sling procedure in female patients?

ObjectiveTo assess if the amount of postoperative postvoid residual of urine that is within the normal range (less than 100 mls) could predict the outcome of TVTO (Tension –free vaginal tape obturator) procedure. Study designSecond Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece. Patients that had been submitted to TVTO procedure between 2013 and 2017 were reviewed and outcome was assessed.The follow up assessment included cough stress test, the Patient Satisfaction Questionnaire (PSQ), the Urinary Distress Inventory-6 (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questionnaire. ResultsThe mean follow-up was 3.7 years (+1.35 years). Forty eight patients (40.3%) had only a TVTO procedure. Forty three patients (36.1%) had a TVTO procedure combined with anterior colporrhaphy. Twenty eight patients (23.6%) underwent a TVTO procedure and anterior colporrhaphy and posterior colpoperineorrhaphy. According to cough stress test 88% patients (105/119) were cured having a negative cough stress test. Using logistic regression analysis it was found that patient’s age (p = 0.78), postoperative postvoid residual of urine ( = 0.24) or day of catheter removal (p = 0.22) had no statistically significant correlation with the medium term outcome of TVTO procedure. Also, regression analysis shows that patients’ Body Mass Index (BMI) has negative correlation to the postoperative outcome. Conclusion(s)PVR < 50 mls appears to be related with successful medium term outcome after TVTO procedure. Also, patients’ (BMI) has negative correlation to the postoperative outcome.

Impact of the mid-urethral sling for stress urinary incontinence on female sexual function and their partners’ sexual activity

ObjectiveTo assess the impact of the transobturator mid-urethral sling (MUS) procedure on female sexual function and their partners’ sexual activity. Materials and methodsSexually active women with stress urinary incontinence who underwent a transobturator MUS procedure at the Department of Obstetrics and Gynecology of two medical centers were prospectively enrolled. All participants and their partners were required to complete questionnaires before surgery and 3 months after surgery. ResultsEighteen women undergoing both the transobturator tape (TOT) procedure (n = 14) and the tension-free vaginal tape obturator (TVT-O) procedure (n = 4) were enrolled. The female sexual function index scores did not differ between the baseline and postoperative data. However, the overactive bladder symptom scores improved significantly 3 months after surgery. Patients also had an improvement in their arousal score after TOT procedures; however, there was no between-group difference in the post-treatment changes in the arousal scores. Thirteen partners completed their questionnaires at both the baseline and postoperative phases. Fifty-four percent (7/13) of partners stated that sexual intercourse improved after surgery, and 46% (6/13) described no change after surgery. In addition, no change in pain level due to vaginal narrowing or dryness after surgery was observed. Only one partner noticed the tape during intercourse and complained of pain due to the tape. ConclusionAlthough most female sexual function remains unchanged after the transobturator MUS procedure, a significant percentage of partners in the study felt that their sexual activity improved after surgery.

Urethral mobility and Point Aa of the Pelvic Organ Prolapse Quantification (POP-Q) system before and after midurethral sling operation.

The aim of the present study was to verify the usefulness of Point Aa as a substitute marker of the Q-tip angle and urethral mobility before and after midurethral sling operation for the treatment of stress urinary incontinence (SUI) in women. In this study, 118 women presenting with SUI who underwent the tension-free vaginal tape obturator (TVTO) procedure were prospectively examined and followed-up for ≥6 months after operation. Spearman's correlation coefficient was used to assess the degree of correlation between Point Aa of the Pelvic Organ Prolapse Quantification system and Q-tip angles before and after midurethral sling surgery. There were significant postoperative changes in Point Aa (from -0.4 ± 1.9 to -2.7 ± 0.6; P = .001) and Q-tip angle (from 58.7 ± 19.4 to 15.4 ± 17.5 degrees; P =.001) compared with preoperative values. A fair correlation between Point Aa position and straining Q-tip angle was found before (r = 0.45, P = .05) and after (r = 0.49, P = .04) the procedure, with no significant difference in values before and after the procedure (P = .62). The results of the present study show fair correlation between the Point Aa position and straining Q-tip angle before and after midurethral sling surgery. Point Aa could be used as an indicator of urethral mobility after the TVTO procedure in women with SUI.

Long Term Quality of Life after Tension-Free Vaginal Tape-Obturator Procedure in Women with Stress Urinary Incontinence

Introduction: Stress urinary incontinence represents a common but strongly underestimated health problem that affects women of all ages and severely downgrades their health related quality of life. The transobturator vaginal tape (TVT-O) approach offers long term success rates, while minimizing complications. In this study, we examined quality of life of patients suffering by stress urinary incontinence and investigated whether TVT-O procedure offers considerable benefits in patient’s quality of life after 5 years of placement. Methods and results: Women with confirmed urodynamic stress urinary incontinence that underwent TVT-O procedure were included in this prospective study. Patient’s quality of life was evaluated by using the Greek version of SF-36 preoperatively and 60 months postoperatively. The outcomes demonstrated that incontinence had significant adverse effect in patient’s quality of life. However, TVT-O procedure offers a safe and efficient treatment, substantially improving both physical and mental dimension of women’s health related quality of life (P&gt;0.05). Discussion: Stress urinary incontinence strongly impairs women’s health related quality of life, limiting their physical activities, social function and causing emotionally imbalance. Insertion of tension free vaginal tape reverses symptoms and significantly improves all health indicators associated with patient’s health related quality of life. In our study, we demonstrate that minimal invasive surgery, by using TVT-O procedure is highly effective, in long term, in improving quality of life of women with stress urinary incontinence.

Ten-Year Followup after Tension-Free Vaginal Tape-Obturator Procedure for Stress Urinary Incontinence

Suburethral tapes are a standard surgical treatment for stress urinary incontinence. The aim of the study was to evaluate subjective and objective cure rates 10 years after a tension-free vaginal tape-obturator procedure. All 124 patients who underwent the tension-free vaginal tape-obturator procedure at a total of 2 centers in 2004 and 2005 were invited for followup. Objective cure was defined as a negative cough stress test at 300 ml. Subjects completed KHQ (King's Health Questionnaire), IOQ (Incontinence Outcome Questionnaire), FSFI (Female Sexual Function Index Questionnaire) and PGI-I (Patient Global Impression of Improvement). Overall, 55 of 112 women (49%) who were alive were available for clinical examination and 71 (63%) completed the questionnaires. The objective cure rate in the 55 women examined clinically was 69%, 22% were not cured and 9% (5) had undergone reoperation for recurrent or persistent stress urinary incontinence. Treatment was counted as having failed in these 5 women for study purposes. Subjective cure was reported by 45 of 71 women (64%). Three patients (5%) had vaginal tape extrusion at the time of clinical examination. Extrusion in all of them was small and asymptomatic, and did not require treatment for a cumulative extrusion rate of 7%. Six women (9%) had undergone reoperation for tension-free vaginal tape-obturator associated complications and 18 (26%) experienced de novo overactive bladder. Subjective and objective cure rates 10 years after the tension-free vaginal tape-obturator procedure were 69% and 64%, respectively. The vaginal extrusion rate in this study was slightly higher than in other series but major long-term complications appeared to be rare.

Predictive factors of bladder outlet obstruction following the tension-free vaginal tape obturator (TVTO) procedure in females treated surgically for stress urinary incontinence

ObjectivesTo identify patients at risk for postoperative outlet obstruction after the tension-free vaginal tape obturator (TVTO) procedure in order to allow for better counseling and possible treatment alternatives. Subjects and methodsThis prospective study was carried out on 85 women who underwent the TVTO procedure for treatment of stress urinary incontinence (SUI). Preoperatively, a detailed medical history was taken from all patients, and all were subjected to physical examination, routine labs, abdominal and pelvic ultrasound and urodynamic studies (cystometry and assessment of the detrusor leak point pressure (DLPP), abdominal leak point pressure (ALPP), pressure flow and post-void residual (PVR) urine). The TVTO procedure was carried out by the same surgeon in all cases. Postoperative voiding dysfunction in this study was defined as the subjective feeling of difficult voiding, a weak stream and/or incomplete evacuation, and a PVR urine volume >100ml, a urine flow rate <15ml/s or urinary retention on examination. The following risk factors for postoperative bladder outlet obstruction were evaluated: age, history of previous incontinence surgery, parity, menopausal status, type of SUI, grade of SUI, residual urine, Qmax and PdetQmax. Statistical analysis was done using the SPSS package version 1.5. Results75% of our patients were cured. Denovo urgency or urge incontinence developed in 5.8% of the patients. Voiding dysfunction according to our definition developed in 24.7% of the patients. On multivariate analysis, Qmax was the only risk factor that could predict postoperative bladder outlet obstruction (p=0.002, odds ratio=0.658, 95% C.I.). ConclusionPreoperative Qmax is the only independent risk factor for postoperative bladder outlet obstruction in women undergoing TVTO surgery. Brief summaryTVTO is an effective surgical option for genuine stress incontinence in females. Preoperative Qmax is the only independent risk factor for postoperative bladder outlet obstruction.

Seven years of objective and subjective outcomes of transobturator (TVT-O) vaginal tape: Why do tapes fail?

This study reports long-term outcomes of the transvaginal tension-free vaginal tape-obturator (TVT-O) procedure for treating stress urinary incontinence (SUI), including possible risk factors for failure. This was a retrospective study of women who underwent TVT-O with or without concomitant prolapse surgery. Procedures were performed at a tertiary referral urogynecology unit. Participants presented with SUI and had urodynamic stress incontinence (USI). Women with a history of previous anti-incontinence procedures, radical pelvic surgery, and detrusor overactivity (DO) were excluded. Objective cure was defined as absence of urine leakage during a cough stress test (CST). Subjective outcome was based on the International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Quality of life was assessed using the King's Health Questionnaire (KHQ). Univariate and multivariate analyses were used to identify risk factors for subjective failure. One hundred twenty-four consecutive women were assessed, with a median follow-up of 90.3 (range 80-103) months. Overall objective and subjective cure rates were 81.5 % (101/124) and 83.5 % (103/124), respectively. A significant improvement was observed in all KHQ domains. Concomitant vaginal hysterectomy [odds ratio (OR) = 2.98, 95 % confidence interval (CI) 1.10-8.05, p = 0.03] and increasing point C (OR = 1.17, 95 % CI 1.05-1.30, p = 0.006] were associated with a higher risk for subjective failure. De novo urgency rate was 7 %. The TVT-O procedure provides high objective and subjective long-term efficacy, a clinically meaningful improvement in patient quality of life, and an excellent safety profile. Concomitant vaginal hysterectomy and apical compartment prolapse were associated with a higher risk for objective and subjective failure.

Measurement of the Q-tip angle before and after tension-free vaginal tape-obturator (TVT-O): preoperative urethral mobility may predict surgical outcome

The purpose of this study was to compare the results of the Q-tip test before and after the tension-free vaginal tape-obturator (TVT-O) in women with stress urinary incontinence (SUI) to determine the value of the Q-tip test in predicting the outcome of transobturator tape (TOT). Between June 2008 and June 2009, 59 women with SUI who underwent the TVT-O procedure and were followed up for at least 6 months were analyzed. Urethral hypermobility was defined as a maximal straining angle greater than 30° as measured by the Q-tip test. Parameters of evaluation included a comprehensive medical history, physical examination, Q-tip test, stress test, and urodynamic study, which included determination of the Valsalva leak point pressure. Cure was defined as no leakage of urine postoperatively either subjectively or objectively, whereas failure was defined as the objective loss of urine during the stress test. The patients were divided into two groups according to their preoperative Q-tip angle: <30° (group 1, n=21) and ≥30° (group 2, n=38). The Q-tip angle decreased significantly in both groups: from 25.9 ± 5.98° preoperatively to 18.4 ± 7.23° postoperatively in group 1 (p=0.04) and from 36.6 ± 6.75° preoperatively to 24.1 ± 5.48° postoperatively in group 2 (p=0.03). The difference was obviously pronounced in group 2. The incontinence cure rate was significantly higher in group 2 (97.4 %) than in group 1 (85.7 %; p=0.04). Our results suggest that mobility of the proximal urethra is associated with a high rate of success of the TVT-O procedure.

Pain after suburethral sling insertion for urinary stress incontinence

Pain after suburethral sling insertion is an uncommon, but troublesome complication of continence surgery; in some cases it can cause significant distress and disability. It is often not recognised, poorly diagnosed and treated by gynaecologists and urologists unfamiliar with the condition. A literature review was performed and the current evidence on pain after suburethral sling insertion reviewed. The tension-free vaginal tape-obturator (TVT-O) procedure is associated with an increased incidence of early groin pain, but this often resolves with expectant management. Chronic pain may be difficult to treat. The injection of local anaesthetic and steroid solutions may provide relief in some patients. Cognitive behavioural therapy has a place in treatment. In resistant cases, surgical excision may be needed. Retropubic slings can be removed laparoscopically or by open exploration of the Cave of Retzius. Obturator tapes may require groin exploration. Sling removal may result in recurrent incontinence and further tissue and nerve damage. It does not always cure pain and may exacerbate the problem.

Effects of a modified technique for TVT-O positioning on postoperative pain: single-blind randomized study

One of the most frequent and distressing complications of the tension-free vaginal tape obturator (TVT-O) procedure for stress urinary incontinence (SUI) is groin pain, which may be related to the surgical technique or to the tape. The aim of this study was to evaluate the impact of a more limited dissection and a more medial trocar trajectory in TVT-O positioning on postoperative pain. Seventy-two SUI patients were randomized to undergo TVT-O either with the traditional technique (group A) or a modified procedure (reduced paraurethral dissection and a more medial trocar trajectory) (group B). Visual analog scale pain scores 12 h, 24 h, and 1 month after the procedure, number of analgesic vials, objective cure rate, and patient functional and quality of life scores 6 months after the procedure were evaluated. Data were analyzed by the Student's t test for parametric variables, the Mann-Whitney U and Wilcoxon tests for nonparametric variables, and Fisher's exact test for categorical variables. Pain scores were significantly lower in group B compared with group A 24 h after surgery (P = 0.01). Pain scores significantly decreased from 12-24 h postoperatively to 1 month follow-up in both groups (P < 0.001). No significant differences were observed in the number of analgesic vials administered, cure rates, and questionnaire scores between the two groups. More limited dissection and a more medial trocar trajectory of TVT-O seem to reduce postoperative groin pain at 24 h after the procedure, but not the analgesic requirement.

Tension-free vaginal tape-obturator in the treatment of stress urinary incontinence: a prospective study with five-year follow-up

To evaluate the medium-term outcomes of using tension-free vaginal tape-obturator (TVT-O) in the treatment of patients with stress urinary incontinence (SUI). Between December 2004 and November 2005, 103 patients with SUI were enroled and treated with TVT-O with inside-out modification. A minimum five-year follow-up (median, 65 months) was obtained from 100 patients (99.6%). Preoperative and postoperative evaluations were performed for all patients. The objective success rate of the TVT-O procedure was evaluated by a negative stress test. The secondary outcomes measured included one- and five-year subjective success rates, together with the pre- and post-operative urodynamic parameters, complications, quality of life (QOL) analysis, and patient satisfaction. Among the 103 patients, 18 (17.4%) had postoperative voiding difficulties and needed urethral bladder catheterization for various periods. After the TVT-O procedure, complete disappearance of SUI occurred in 87.4% of patients, while improvement was found in about 92%. In addition, there was no difference in the cure rate between year 1 and year 5 after the procedure (P>0.05). In 90 patients, frequency and urge symptoms were significantly improved five years after the procedure (P<0.005), and maximal flow rates were decreased (P<0.05). However, the severity of obstructive symptoms and postvoid residual volumes at five years were not improved compared with one year after the procedure (P=0.10 and P=0.33 respectively). Finally, compared to pre-operation, incontinence severity degree and QOL scale scores were largely improved after the operation (P<0.001), while no difference was found between years 1 and 5 (P=0.11and P=0.09 respectively). Our result shows that the TVT-obturator, a novel mid-urethral sling, is a safe and effective procedure for the treatment of female SUI. Medium-term therapeutic results appear promising but further evaluation of long-term therapeutic outcomes is needed.

Transobturator vs Single-Incision Suburethral Mini-slings for Treatment of Female Stress Urinary Incontinence: Early Postoperative Pain and 3-Year Follow-up

Study Objective To compare related pain and cure using the transobturator and single-incision suburethral mini-sling anti-incontinence operations. Design Open, prospective, nonrandomized 2-armed study comparing 2 surgical procedures for treatment of female stress urinary incontinence (Canadian Task Force classification II-1). Setting A university and a private hospital. Patients One hundred sixty-two women with stress urinary incontinence underwent either a tension-free vaginal tape–obturator (TVT-O) or a single-incision (TVT-SECUR) suburethral or mid-urethral tape operation. Measurements and Main Results Pain levels were estimated using a visual analog scale, and outcome using the Urinary Distress Inventory and the Incontinence Impact Questionnaire. Postoperative vaginal and thigh pain was transient, lasting for up to 2 weeks, and occurred significantly more frequently in the TVT-O group (32% vs 1% and 32% vs 0%, respectively). Dyspareunia was not self-limited, and occurred more frequently in the TVT-SECUR group (7.9% vs 0%). Cure rates were 86.9% in the TVT-O group and 90.9% in the TVT-SECUR group. Complication rates were similar in the 2 groups. Conclusion Both procedures were effective, with few adverse effects. In sexually inactive patients, the TVT-SECUR procedure may be preferable because thigh and vaginal pain is largely averted with this procedure. Sexually active patients might be better referred for the TVT-O procedure because it was not followed by dyspareunia in our series. Patient choice of surgical method rather than randomization weakened the strength of this study.

Impact of the tension-free vaginal tape obturator procedure on sexual function in women with stress urinary incontinence

Objective To evaluate prospectively the impact of the tension-free vaginal tape obturator (TVT-O) procedure on sexual function in women with stress urinary incontinence (SUI). Methods The present prospective study included women with SUI and no concomitant prolapse who underwent a TVT-O procedure at Fuzhou General Hospital in Fuzhou, Fujian, China. Before and 6 months after surgery, the patients had their sexual function evaluated using the Female Sexual Function Index (FSFI) questionnaire. Only sexually active women were included in the final analysis. Results Among the 55 sexually active patients, 21.8% had coital incontinence, which was cured in 11 of 12 patients (91.7%). More than half (54.5%) the women reported an improvement in sexual function after surgery and 45.5% reported no change. No statistically significant difference was found between preoperative and postoperative total or domain (desire, arousal, lubrication, orgasm, satisfaction, and pain) scores on the FSFI. Conclusion The TVT-O procedure in women with SUI did not significantly affect sexual function. Further studies are needed to verify the findings and compare the impact of TVT-O on sexual function with that of other anti-incontinence procedures.

Factors predicting failure after the tension-free vaginal tape obturator procedure for stress urinary incontinence

Objective: The present study evaluated clinical factors associated with failure following use of the tension-free vaginal tape obturator (TVT-O) procedure for stress urinary incontinence (SUI). Methods: The retrospective study involved 141 patients who underwent surgery for urodynamic stress incontinence be- tween January 2004 and December 2008 with follow-ups for at least 1 year postoperatively. Medical records were reviewed to obtain clinical characteristics and surgical outcomes. Failure was defined as a subjective complaint of leakage at 1-year after surgery. Results: The TVT-O success rate was 92.9%. The success and failure groups were found to be similar in terms of demo- graphic and clinical characteristics. Preoperative urodynamic study showed that the only factor associated with failure was a preoperative abdominal leak point pressure (ALPP) <60 cm H2O (odds ratio, 5.14; P=0.035). Conclusion: The present study found that an ALPP<60 cm H2O was independently predictive of failure in SUI patients un- dergoing the TVT-O procedure.

Short-term Impact of Tension-free Vaginal Tape Obturator Procedure on Sexual Function in Women with Stress Urinary Incontinence

The tension-free vaginal tape obturator (TVT-O) procedure is one of the most commonly used anti-incontinence surgeries, but little is known about its impact on sexual function. To evaluate sexual function after the TVT-O procedure at 6 months postoperatively. Fifty-six sexually active women who underwent the TVT-O procedure for severe stress urinary incontinence (SUI) were evaluated using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 6 months after surgery. The perception of incontinence-related quality-of-life were also evaluated by the short form of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) to assess the effect of surgery on incontinence. Total score and score for each PISQ-12 item. The mean total PISQ-12 score did not differ significantly before (24.0 + or - 12.2) and after (23.0 + or - 13.2) (P = 0.194) the TVT-O procedure. Scores for individual items on the PISQ-12 varied, with incontinence-related items improving but others, such as the frequency of achieving orgasm deteriorating for some women. The scores of UDI-6 and IIQ-7 were significantly improved by 6-month follow-up, indicating that the operation successfully resolved the incontinence. Despite successful amelioration of SUI by the TVT-O procedure, sexual function does not necessarily improve in the first 6 months after surgery.

Tension‐free vaginal tape‐obturator procedure for treatment of severe urodynamic stress incontinence: Subjective and objective outcomes during 2 years of follow‐up

To report our experience of the tension-free vaginal tape-obturator (TVT-O) procedure for the treatment of severe female urodymanic stress incontinence (USI) during 2 years of follow-up. Between January 2005 and June 2007, 67 women with severe USI who underwent the TVT-O procedure were enrolled in the study. Pelvic examination, pad test, urodynamic study, and quality of life (QoL) assessment were performed pre- and post-operatively. Regular follow-up was arranged for analysis. The median duration of follow-up was 24 months. The objective cure rate was 76.2%. The postoperative pad test revealed significant reduction of leakage. The subjective cure rate was 83.5%, and improvement occurred in 14.9%. The postoperative QoL showed significant improvement. One (1.5%) extrusion of tape occurred and three cases of de novo detrusor overactivity were detected. Three patients (4.4%) had immediate postoperative urine retention. No major complications occurred. Our results show that the TVT-O procedure is an effective and safe surgical procedure for severe female USI with satisfactory outcomes, significant improvement in quality of life, and few complications during 2 years of follow-up.