Tension-free Vaginal Tape Operation 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.

Increased Rate of Mesh Erosion in Breast Cancer Survivors Taking Antiestrogen Therapy.

There are no current data investigating the relationship between mesh-exposure complications after midurethral sling surgery and antiestrogen therapy. We sought to determine if there are increased mesh-exposure complications between a breast cancer population versus a noncancer population particularly in conjunction with hormone suppression (HS) therapy. A retrospective chart review was performed on patients with a history of breast cancer undergoing tension-free vaginal tape (TVT) surgery at our institution between 2013 and 2021. A group of patients who underwent TVT surgery without a history of cancer served as our control. Univariate and multivariate logistic regression analyses were performed to identify predictors of mesh exposure complications. One hundred twenty-one patients with breast cancer had TVT surgery. Two hundred ninety-seven patients without cancer had TVT surgery during the same period. Baseline characteristics across all groups were similar. Twenty-nine patients (6.9%) experienced mesh exposure. This occurred at a higher rate in our cancer (15.7%) versus the noncancer population (3.4%). Women with breast cancer taking HS therapy had a higher rate of mesh exposure complications compared with those not taking HS therapy (25.0% versus 6.6%; P = 0.005). The highest rate of mesh exposure complications occurred in the cohort taking estrogen receptor modulators, selective estrogen receptor modulator (10/36 [27.8%]) versus aromatase inhibitors (5/24 [20.8%]) versus no HS therapy (4/61 [6.6%]; P = 0.014). On multivariate analysis, HS therapy use (odds ratio, 1.57; P = 0.007) and diabetes mellitus (odds ratio, 4.53; P = 0.018) were associated with increased TVT-related complications. Women with breast cancer had a higher rate of mesh exposure complications from TVT surgery compared with women without cancer, particularly those taking antiestrogenic therapy.

Rates of subjective and objective cure, satisfaction, and pain 10-20 years after tension-free vaginal tape (TVT) surgery: A retrospective cohort study.

To evaluate rates of subjective and objective cure, treatment satisfaction, pain, and the correlation between cure and body mass index (BMI), at 10 and 20 years after tension-free vaginal tape (TVT) surgery. Retrospective cohort study. Multicentre study including 19 units in Norway. Women undergoing TVT surgery for stress urinary incontinence (SUI) during 2001-2006 (20-year cohort) and 2011-2012 (10-year cohort). The Norwegian Female Incontinence Registry was used to identify women eligible for the study, who answered validated questionnaires about urinary incontinence, pain and satisfaction. Subjective cure of SUI (with stress index of <3, range 0-12), objective cure (<3 g on stress test) and persisting pain and satisfaction after TVT (scored on a five-point Likert scale). In total, 1210 of 1903 (64%) patients responded. The subjective cure rate was 68% after 10 years, versus 59% after 20 years, and did not significantly differ after adjusting for age, BMI, parity and preoperative stress index (adjusted OR 1.27, 95% CI 0.82-1.94). The objective cure rate was 100% versus 93% (P < 0.001), with 89% versus 76% reporting subjective satisfaction (P < 0.001), and with 4.7% versus 2.7% reporting persisting pain (P < 0.001), after 10 versus 20 years, respectively. Women in obesity classes I and II, compared with women of normal weight, had an increased risk of not being subjectively cured (crude OR 2.02, 95% CI 1.42-2.90; OR 2.95, 95% CI 1.60-5.46, respectively). Tension-free vaginal tape (TVT) provided high rates of subjective and objective cure at 10 and 20 years after surgery, with no significant difference between the two cohorts. Although 3%-5% of women experienced persisting pain, most women were satisfied with TVT surgery. Obesity was associated with a lower cure rate.

Evaluation of tension-free vaginal tape and transobturator tape surgery performed in one year in terms of mesh erosion

Background/Aim: Mesh erosion is one of the feared complications in surgeries performed using mesh, and its frequency is increasing as more and more of these surgeries are performed. This study aims to evaluate transobturator tape (TOT) and tension-free vaginal tape (TVT) surgeries performed in the surgical treatment of stress urinary incontinence (SUI) in our clinic in terms of clinical results and mesh erosion. Methods: This study is a retrospective cohort study. The files of 50 patients who had SUI and underwent TOT and TVT surgery in our clinic between January 2022 and January 2023 were reviewed. Patients diagnosed with pure SUI and for whom surgery was performed were included in our study. The participants were divided into two groups: those who had TOT surgery and those who had TVT surgery. These groups were evaluated and compared in terms of mesh injury, mesh erosion, pelvic pain, dyspareunia symptoms, and urinary retention. The surgical data of patients, incidence of complications, pre- and postoperative incontinence impact questionnaires (IIQ-7) and the scores of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) were recorded. Results: The mean follow-up period of the participants was 8.96 (8.47) (range, 6-17 months). TVT surgery was performed on 13 participants and TOT surgery was performed on 37 patients. When the two groups were compared, there was no statistically significant difference in terms of age, body mass index (BMI), parity, menopausal status, duration of incontinence, preoperative IIQ-7 scores, and ICIQ-SF scores (P&lt;0.05). There were no statistically significant differences between surgical durations, length of hospital stay, early surgical complications, postoperative 3rd month IIQ-7, and ICIQ-SF scores (P&lt;0.05). Furthermore, no difference in the rates of mesh erosion and mesh-related complications between the two groups (P&lt;0.05) was observed. Conclusion: TOT and TVT surgeries seem to be quite safe in terms of complications, as well as being satisfactory in terms of patient satisfaction. Although mesh-related complications can be frightening, the rate of regression is low with appropriate management. Our results show that both operations are safe with an acceptable complication rate when performed by surgeons who have experience with anti-incontinence procedures.

Agents, Techniques, and Complications of Local Anesthesia: Experience in a Tertiary Care Hospital

Introduction: Local anesthesia has opened a new door for surgeries recently as a replacement of general anesthesia. The complications of general anesthesia can be minimized using local anesthesia as a substitute. Aim of the Study: The aim of this study was to evaluate the agents, techniques, and complications of local anesthesia. Methods: This cross-sectional study was conducted in department of Anesthesiology and Gynaecology, Rangamati Medical College Hospital, Rangamati, Bangladesh, during the period from July 2020 to June 2022. Total 60 patients having different surgeries were included in this study. Lidocaine, Bupivacaine and Chloroprocaine were used for different surgical procedures. 2% lidocaine, 0.5% bupivacaine and 2% chloroprocaine were given along with adrenaline after dilution. After collection of data, statistical analysis was done using SPSS version 22. Numerical variables were expressed as mean and standard deviation, whereas categorical variables were count with percentage. Result: In this study, mean age was found 56.6 years (SD±4.50 years). Mean hospital stay was 2.2 days (SD±1.4 days). Mean blood loss was 86 mL (SD±26.4 mL). In anterior vaginal wall repair surgery, 5 (23.8%) patients had bleeding and 1 (4.8%) patient had urinary retention. In vaginal correction surgery, 2 (7.7%) patients had nausea, 1 (3.85%) patient had congestive heart failure and 1 (3.85%) patient had superficial thrombophlebitis. In Tension-Free Vaginal Tape surgery, 2 (15.4%) patients had myocardial infarction, 1 (7.7%) had bleeding and 1 (7.7%) had nausea. Conclusion: Local anesthesia has been successful for different surgical procedures. Though there were very few complications using local anesthesia for anterior vaginal wall repair, vaginal correction and Tension-Free Vaginal Tape surgery.

Bladder filling test, cystoscopy, or both for checking bladder perforation in tension-free-vaginal tape operations

Background/Aim: Tension-free-vaginal tape (TVT) has been widely used for treatment of stress urinary incontinence as a mid-urethral sling operation. Cystoscopy is routinely performed during tension-free-vaginal tape operations to check for bladder perforation or injury. This study aims to check the applicability and accuracy of the bladder filling test for predicting bladder perforation in tension-free-vaginal tape operations. Methods: Between 2015 and 2020, 285 women who had TVT operations were subject to evaluation. Out of 285 cases, 23 cases were suspected subjectively by the operating surgeons to have visible or occult bladder perforation during the TVT procedure. A routine cystoscopy was performed at the end of all operations. Additionally, before the routine cystoscopy, in cases suspected of a visible or occult bladder perforation, the bladder was filled with 500 ml saline or diluted methylene blue dye through a urinary catheter (bladder filling test) to check for occult bladder perforation that might not be visualized by cystoscopy. Any fluid leakage through the paraurethral dissected canals or from the abdominal incisions was observed for the possibility of bladder perforation. The accuracy of the bladder filling test was compared to cystoscopy to diagnose bladder perforation in suspected cases. In addition, all cases were followed up for three months to record any cases with late or occult bladder perforations missed in the diagnosis using cystoscopy or the bladder filling test perioperatively. Results: Out of 23 cases suspected subjectively by the operating surgeons to have visible or occult bladder perforation, 11 had visible bladder perforations (3.9%) confirmed by both cystoscopy and the bladder filling test. After the filling test, leakage at the abdominal incision site and/or para-urethral dissected canal was observed in all cases with bladder perforation. No leakage was observed in the remaining patients (n = 12) suspected of, but not diagnosed with bladder perforation by cystoscopy. The bladder filling test did confirm the same diagnosis revealed by cystoscopy in all suspected cases. Conclusion: The bladder filling test was found to be very sensitive in predicting bladder perforation at tension-free-vaginal tape operations compared to cystoscopy. This test can decrease the need for routine cystoscopy at tension-free-vaginal tape insertion, and cystoscopy can be limited to cases with leakage in the bladder filling test.

Tension-Free Vaginal Tape and Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: 3-Year Followup from a Randomized Clinical Trial.

We sought to determine whether polyacrylamide hydrogel (PAHG) is noninferior to tension-free vaginal tape (TVT) in the treatment of women with primary stress urinary incontinence (SUI). In this noninferiority trial, 223 women eligible for operative SUI treatment were randomized for TVT (110) or PAHG (113). Primary outcome was patient satisfaction and the noninferiority margin for the difference was 20%. Secondary outcomes were effectiveness and complications. At 3 years, 188 (84.3%) women attended the followup. The satisfaction score (visual analogue scale 0-100) median was 98.5 (IQR 90-100) in the TVT group and 90.0 (IQR 70-100) in the PAHG group, whereas a score ≥80 was reached in 87 (94.6%) and 65 (67.7%), respectively (difference 26.9%, 95% CI 16.7% to 36.8%). Thus, PAHG did not meet the noninferiority criteria set in our study. The cough stress test was negative in 88 (95.7%) of TVT patients vs 75 (78.1%) of PAHG patients (difference 17.5%, 95% CI 8.6% to 26.9%). Any peri- or postoperative complication before crossover between the groups was detected in 40 (43.5%) women in the TVT group and 23 (24.0%) women in the PAHG group (difference 19.5%, 95% CI 6.8% to 31.4%). In midterm followup, PAHG did not reach in patient satisfaction the noninferiority set in our study. Furthermore, mid urethral TVT slings show better subjective and objective cure rates than PAHG. However, complications were more often associated with TVT. Since the majority of PAHG treated women were also cured or improved, primary SUI women can be offered PAHG as a safe and durable alternative treatment.

Systematic review and meta-analysis of the efficacy of tension-free vaginal tape on pelvic organ prolapse complicated by stress urinary incontinence.

Patients with pelvic organ prolapse combined with stress urinary incontinence (SUI) require pelvic floor repair and surgical treatment; however, there is currently no systematic evaluation of the treatment effect. PubMed, Medline, Embase, Elsevier, The Cochrane Library, Web of science, and other databases were searched for randomized controlled trials (RCTs) published between January 2000 and December 2020 regarding tension-free vaginal tape (TVT) treatment of pelvic organ prolapse combined with SUI. Quality evaluation of the articles included in this study was conducted in accordance with the Cochrane Work Manual (5.3), and RevMan 5.3 software was used to conduct meta-analysis of the data extracted from literature meeting the requirements. A total of 10 articles were included, involving a total of 1,361 subjects, including 553 in the control group (a different surgical treatment) and 808 in the observation group (single TVT or TVT combined with pelvic floor repair). The bias evaluation results showed that all of the included literature was rated as level B, so there was no need for sensitivity analysis. The meta-analysis showed that the combined effect size of the clinical cure rate was {odds ratio (OR) [95% confidence interval (CI)]: 3.82 (1.39, 10.52); Z=2.59, P=0.010}, and the combined effect size of the clinical complication rate was [risk difference (RD) (95% CI): -0.09 (-0.16, -0.02); Z=2.38; P=0.02]. The results showed that the clinical cure rate of the observation group was significantly higher than that of the control group, while the clinical complication rate was significantly lower than that of the control group (P<0.05). TVT surgery or TVT combined with pelvic floor repair surgery can significantly improve the cure rate of patients with pelvic organ prolapse combined with SUI, and reduce the incidence of postoperative complications. Therefore, TVT is a suitable surgical method for the treatment of patients with pelvic organ prolapse combined with SUI.

Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann–Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67–8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03–1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85–2.38) and defect type (p = 0.02, B – 1.42, 95% CI – 2.65 to – 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.

Nomogram for preoperative estimation of prognosis after retropubic tension free vaginal tape in female patients with stress urinary incontinence.

To identify risk factors by developing a nomogram for predicting surgical outcomes for female patients who underwent tension free vaginal tape (TVT) for stress urinary incontinence (SUI). Data on 365 patients with pure SUI who underwent TVT at the Shanghai General Hospital between February, 2017 and July, 2018, were retrospectively collected. Within this group, symptoms of patients who were found to have disappeared or have been improved (subjective success group) were compared with symptoms of those patients who were found to have no change or recurrence (subjective failure group). We evaluated the effect of treatment after TVT surgery on SUI patients based upon patient prognosis. During the study period, 327 women underwent TVT surgery and met the qualifications for inclusion in six-month follow-up consultations and 38 patients were lost. Multivariable logistic regression analysis of risk factors that were important in relation to the failure of surgery indicated two independent predictors: total cholesterol (TC) (P=0.005) and maximal urethral closure pressure (MUCP) (P=0.028). We developed a nomogram to predict prognosis after TVT in female patients with SUI using these parameters. We developed a predictive model for preoperative estimation of prognosis in female patients who underwent TVT based treatment for SUI. This model could select patients who were found to have successful postoperative outcomes, which can lead to a rational therapeutic choice.

Effect of surgeon volume on long-term quality of life outcomes following tension-free vaginal tape surgery.

The role of the general obstetrician/gynaecologist completing routine urogynaecology procedures is controversial, and some research has suggested that these patients should be referred to high-volume subspecialists. In response to recent public and regulatory scrutiny of vaginal mesh procedures, credentialling guidelines have been released in Australia requiring surgeons to demonstrate a minimum caseload prior to performing tension-free vaginal tape (TVT) surgery for incontinence. Hence, a retrospective cohort study was conducted to evaluate the long-term quality of life outcomes of TVT procedures for high- and low-volume surgeons. One hundred seventy patients who had undergone TVT surgery between 1 May 2011 and 1 May 2016 in the Sunshine Coast health district were invited to complete the UDI-6 (Urinary Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) surveys. Perioperative information was accessed from available health records. Mean UDI-6 and IIQ-7 scores were compared for high- and low-volume groups, and the groups were assessed for confounding factors. Of the 170 patients eligible, 83 completed the surveys (47.2%). No differences in UDI-6 or IIQ-7 scores were found between high- and low-volume surgeons (p > 0.05). High-volume surgeons completed more concomitant procedures amongst survey respondents (p < 0.05), though this was not reproduced when considering all 170 patients eligible for the study. There were no significant differences in age, ASA (American Society of Anaesthesiologists) score or complication rate amongst survey respondents. Amongst the patients surveyed, high- and low-volume surgeons had similar long-term quality of life outcomes for TVT surgery, without any significant difference in complication rate.

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.

A Simple Approach for Relieving Voiding Dysfunction After Tension-Free Vaginal Tape: Safety Stitch

Voiding dysfunction is one of the most common postoperative complications of the tension-free vaginal tape procedure. The aim of this study was to show the effectiveness of loosening the tape with a simple approach. A total of 84 women underwent a tension-free vaginal tape operation for stress urinary incontinence. While operation was performed, a prolene suture–safety stitch was inserted in the middle of the tape. Then vaginal incision was closed by extracting the prolene stitch outside. Thus prolene suture will be pulled with a clamp when patient complaint of voiding dysfunction at the postoperative period. A total of 18 patients (21.4%) experienced voiding dysfunction at the postoperative 1-month follow-up period. Sixteen patients (%19) were performed transvaginal tape mobilization within 3 days (range 1–5) after the primary procedure. No complications were observed with the mobilization. Two patients(2.3%) performed clean intermittent catheterization for a period of more than 1 day, with an average of 14.4 days (range 3–63). After tape mobilization, 15 women (93.7%) were recovered from voiding dysfunction and were continent. One woman was incontinent after mobilization. The incidence of voiding dysfunction requiring tape mobilization was 19%. Pulling the safety stitch without anesthesia and without reopening the vaginal incision is a simple, safe, and effective way for tape mobilization to relieve voiding dysfunction.

Sexual function after tension-free vaginal tape procedure in stress urinary incontinence patients.

The aim of the study was to evaluate sexual function in women before and after tension-free vaginal tape (TVT) surgery for the treatment of stress urinary incontinence (SUI). Between August 2014 and August 2018, 105 sexually active patients with SUI who underwent TVT surgery were enrolled in this prospective cohort study. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12) was administered pre- and postoperatively. Statistical analyses were performed using paired-sample t tests. The sexual function of 105 patients 1 year after the TVT procedure improved in 81 (77.1%) patients, remained unchanged in 18 (17.1%) patients, and deteriorated in 6 (5.7%) patients. The mean PISQ-12 score increased from 29.65 at baseline to 33.04 at the 1-year follow-up (P < 0.001). Improvement was prominent in the physical domain of the PISQ-12 (P < 0.001), but the emotional (P = 0.948) and partner-related (P = 0.915) domains showed no significant changes. The increase in the physical domain score caused the increase of the total PISQ-12 score. Compared with preoperative values, there was no significant change in the score of pain during sexual intercourse (P = 0.425) at 1 year after the TVT procedure. Women experienced less coital incontinence (P < 0.001), less fear of incontinence during intercourse (P < 0.001), and less negative emotional reactions (P < 0.001) during intercourse after the TVT operation than before the TVT operation. Sexual function was improved in patients with SUI after TVT surgery.

Complications and re-operations after tension-free vaginal tape operation in women with stress urinary incontinence.

We evaluate intraoperative and short-term postoperative (≤ 3months) complications and long-term re-operations (up to 6years) after tension-free vaginal tape (TVT) operation in women with stress urinary incontinence (SUI). Data from 446 women undergoing TVT operation between 2012 and 2016 at a tertiary referral center was retrospectively collected. Data included patient baseline demographics, information from the TVT operation and the following postoperative period, and scores from patient questionnaires [the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Patient Global Impression of Improvement (PGI-I)]. Collected data were investigated for incidence of complications and re-operations, postoperative improvement in patient questionnaires, and association between complications and baseline patient demographics. The only intraoperative complication was bladder perforation (2.0%). Postoperative complications included: infection (0.7%), hematoma (0.9%), bleeding (0.2%), pain (0.9%), erosion of the vaginal mucosa (1.1%), persistent SUI (0.7%), and voiding dysfunction > 24h (10.3%). Re-operations included: operation due to infections (0.4%), incontinence surgery for persistent SUI (0.4%), revision for tape erosion (1.1%), tape mobilization (3.6%), and tape division (0.2%). A significant reduction in urinary incontinence symptoms was observed in the ICIQ-UI SF and PGI-I. The reduction in ICIQ-UI SF did not vary significantly between patients with and without complications. No association between complications and baseline patient demographics was found. This study demonstrated high safety and efficacy of the TVT operation with only minor short-term complications and few long-term re-operations. The ICIQ-UI SF improved significantly postoperatively and was not statistically significantly affected by the occurrence of complications.

Correction of Cystocele and Stress Urinary Incontinence with Combined TVT and Classical Repair versus Bologna Operation

Objective: To evaluate the effectiveness of combined correction of cystocele and tension free vaginal tape (TVT) versus Bologna procedure for treating cystocele with urinary stress incontinence. Study design: Eighty ladies with cystocele with USI. Forty cases experienced, careful repair of cystocele joined with TVT activity and the other forty submitted to the Bologna strategy. All patients were examined and evaluated via questionnaire. Results: Urinary continence was restored in 90% of patients subjected to TVT operation compared with 87.5% for those subjected to the Bologna procedure. Conclusion: Both TVT and Bologna procedure are the safe methods to treat cystocele with stress urinary incontinence and yield good results.

Surgeon's experience and clinical outcome after retropubic tension-free vaginal tape-A case series.

The retropubic tension-free vaginal tape procedure has been the preferred method for primary surgical treatment of stress and stress-dominant mixed urinary incontinence in women for more than 20years. In this study, we assessed associations between surgeon's experience with the primary tension-free vaginal tape procedure and both perioperative complications and recurrence rates. Using a consecutive case-series design, we assessed 596 patients treated with primary retropubic tension-free vaginal tape surgery performed by 18 surgeons from 1998 through 2012, with follow up through 2015 (maximum follow-up time: 10years per patient). Data on perioperative complications and recurrence of stress urinary incontinence from medical records was transferred to a case report form. Surgeon's experience with the tension-free vaginal tape procedure was defined as number of such procedures performed as lead surgeon (1-19 ["beginners"], 20-49 and ≥50 procedures). All analyses were done with a 5% level of statistical significance. We applied the Chi-square test in the assessment of perioperative complications. The regression analyses of recurrence rate by number of tension-free vaginal tape procedures performed were restricted to the three surgeons who performed ≥50 procedures. We found a significantly higher rate of bladder perforations (P=.03) and a higher rate of urinary retentions among patients whose tension-free vaginal tape procedures were performed by "beginners" (P=.06). We observed a significant reduction in recurrence rates with increasing number of tension-free vaginal tape procedures for one surgeon (P=.03). Surgeon's experience with the tension-free vaginal tape procedure is associated with the risk of bladder perforation and urinary retention, and may be associated with the long-term effectiveness of the procedure.

The challenge of complex wound healing caused by necrotizing fasciitis after infection of tension-free vaginal transobturator tape (TVT-O) incontinence material

Pelvic organ prolapse with or without stress urinary incontinence (SUI) is a common gynecological condition that occurs predominantly in middle and old age. Tension-free vaginal tape (TVT) technique is a surgical procedure for treatment of female SUI that is used worldwide. Severe complications are extremely rare. The authors present treatment methods with which they have successfully used for such cases. The Ljubljana University Medical Center carried out 2,587 TVT operations for genuine SUI between 1998 and 2017. The authors carried out a retrospective study to determine long-term success. However, in all of these years, they treated only two serious complications involving necrotizing fasciitis. Both patients were 61-years old, the first patient suffered necrotizing fasciitis shortly after her transobturator TVT (TVT-O) procedure, and the second six years after the initial surgery. Both of them had had repeated extensive fasciectomy, soft tissue debridement, and various modern wound dressing changes, and one of them had had negative pressure wound therapy. Severe complications of TVT-O are rare but present a possibility for great morbidity and mortality. Early surgical treatment plays an important role, together with additional medication.

EP36.06: Transperineal ultrasound assessment of anatomical changes before and after surgery with tension‐free vaginal tape for stress urinary incontinence

To study changes in symptoms and bladder neck in women undergoing tension-free vaginal tape (TVT) surgery for stress urinary incontinence (SUI). Secondarily, to study any association between postoperative anatomy, TVT placement and symptoms. Prospective observational study of 65 women with SUI assessed on the day of TVT surgery and 6 months later. They answered yes/no to questions about SUI and urge urinary incontinence (UUI). Transperineal ultrasound was used to assess urethral funneling at Valsalva and abnormal bladder neck descent (BND) defined as > 25 mm descent from rest to Valsalva. The distance from the TVT to the bladder neck at rest and to the symphysis at Valsalva were measured. Any differences between pre- and postoperative symptoms and anatomy and any association between postoperative anatomy and SUI were tested with Fisher's exact, X2 or t-test. Mean (SD) age was 50 (9) years and BMI 26.3 (4.5) kg/m2. Table 1 compares symptoms and anatomy before and after surgery. 52/60 (87%) women were cured for SUI. Women with persistent SUI had similar postoperative anatomy and TVT placement as cured women: BND > 25 mm 0/6 (0%) vs. 4/51(8%), funneling 0/6 (0%) vs. 16/51 (31%), TVT distance from bladder neck 2.2 (0.7) cm vs. 2.1 (0.5) cm, and from symphysis 1.6 (0.3) cm vs. 1.5 (0.3) cm; all p > 0.05. TVT surgery had a high cure rate for SUI. Women with mixed incontinence had less UUI after surgery and funneling was significantly reduced. No association between persistent SUI, BND, funneling or TVT placement was found. Persistent SUI could be associated with other factors, such as hormonal status and intrinsic urethral pressure. EP36.06: Table 1. 65/65 100% 8/60 13% 38/65 61% 11/60 18% 13/65 20% 4/57 7% 25/65 39% 16/57 28% Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

PD02-01 SUCCESS AND SATISFACTION OF TENSION-FREE VAGINAL TAPE SURGERY IN FEMALES WITH STRESS URINARY INCONTINENCE: RESULTS AT 17 YEARS OF FOLLOW-UP

INTRODUCTION AND OBJECTIVES:The present study was aimed to evaluate the surgical outcomes at 17 years after the Tension-free Vaginal Tape (TVT) surgery which was performed to manage females with st...