Tension-free Vaginal Tape Procedure Research Articles

No mess with mesh; vaginal natural orifice transluminal endoscopic surgery (vNOTES) autologous posterior rectus fascia mesh for vaginal urinary incontinence procedures

Urinary incontinence affects 25–45 % of women with the gold standard surgical approach being placement of mid-urethral synthetic slings; tension-free vaginal tape (TVT) and trans-obturator tape (TOT). Due to the controversies regarding vaginal mesh the last decade, an increasing demand has evolved for incontinence treatment without vaginal synthetic mesh. The short term results of autologous rectus fascia sling for TOT surgery have shown similar success rates compared to those after the use of synthetic mesh, but the harvesting of the mesh is less minimally invasive and is associated with longer surgical time.vNOTES is a combination of a vaginal entrance to the abdomen and endoscopy via the vagina.The aim with the video is to show a new surgical technique with a fully vaginal, scarless vNOTES approach for harvesting the posterior rectus fascia for TVT and TOT procedures.

Intra-obturator bupivacaine injection and post-operative pain following the trans-obturator tension-free vaginal tape procedure: randomized study.

To assess the effectiveness of a long-acting anesthetic injection into the obturator membrane for pain relief in women undergoing trans-obturator tension-free vaginal tape. A total of 22 women were randomized for the intra-operative injection of bupivacaine into one of their obturator membranes: the left or right side. All the participants were asked to define their groin pain on a visual analog scale (scored 0-10 cm) at 1, 6, 12, and 24h post-operative. For each woman, pain scores were compared between the local anesthetic-injected side and the opposite side. Statistically significant differences were not observed in groin pain scores between the bupivacaine injection side and the no injection side at 1h (p = 0.76), 6h (p = 1), 12h (p = 0.95), and 24h (p = 0.82) post-operative. In women who undergo trans-obturator tension-free vaginal tape procedures, intra-operative intra-obturator injection of local anesthetics is not effective in alleviating the characteristic post-operative groin pain. This study is registered on ClinicalTrials.gov (NCT03479996).

Retrospective analysis of the efficacy and safety of polyacrylamide hydrogel (Bulkamid®) peri-urethral bulking injection at the time of pelvic floor repair in women with pelvic organ prolapse and urodynamic stress incontinence.A pilot study

Aims:Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions that often co-exist. One way of managing women with both conditions is to perform a combined surgical approach with a tension-free vaginal tape (TVT) placed at the time of pelvic floor repair. Raised awareness of complications associated with mesh in the UK has led to a pause in TVT procedures meaning there is no widely available one-step surgical procedure for these patients. We aim to investigate whether peri-urethral bulking with polyacrylamide hydrogel (Bulkamid®) performed at the time of pelvic floor repair is a safe procedure and whether it improves stress urinary incontinence. Methods:Validated questionnaires (ICIQ-UI-SF and ICIQ-VS) were completed by women undergoing peri-urethral bulking alone for stress urinary incontinence (SUI), and women undergoing concomitant pelvic floor repair and peri-urethral bulking for POP and SUI. The scores from questionnaires pre- and post-operatively, and any surgical complications were documented and compared. Results:Both control and study groups showed overall improvement in continence scores with the average improvement in the study group being 7.24 and in the control group being 4.73. Statistical analysis showed that the difference in ICIQ-UI SF scores between the two groups was not statistically significant) (p = 0.059). Using the global impression questionnaire, 80% of women from the study group and 65.4% in the control group reported improvement in their incontinence symptoms. Conclusion:Peri-urethral bulking performed at the time of pelvic floor repair improves urinary symptoms and is a safe procedure.

Exploring the Challenges of Using Minimal Invasive Surgery to Treat Stress Urinary Incontinence: Insights from a Retrospective Case-Control Study

Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105–1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case.

Impact of Defined Risk Factors on Degree of Urinary Stress Incontinence and Sling Outcome: A Retrospective Cohort Analysis.

Urinary stress incontinence is a distressing condition that has a severe impact on quality of life for most affected women. The insertion of the suburethral tension-free vaginal tape (TVT) is regarded as the gold-standard surgical treatment option. It is unclear whether all women with severe SUI benefit equally from TVT. Thus, the aim of our study was to identify risk factors for severe SUI and determine whether successful the resolution of incontinence after a TVT procedure was different in women with a higher degree of SUI. In total, 168 women were included in this retrospective cohort study. Women with severe SUI showed a significantly lower maximum urethral closure pressure (MUCP) (median 53 cmH2O in moderate vs. 39 cmH2O in severe, p = 0.001) and higher BMI (median 26.1 kg/m2 in moderate vs. 28.5 kg/m2 in severe, p = 0.045). Sonographic bladder neck funneling was detected significantly more often in women with severe SUI (27% in moderate vs. 57% in severe, p = 0.004). Lower MUCP and higher BMI were identified as significant predictors of severe SUI (p < 0.032). There was no difference in parity, age, functional urethral length and negative urethral stress pressure. Overall postoperative continence after the insertion of TVT was 91.9%. We found no significant difference in postoperative continence between women with severe vs. moderate SUI, suggesting that in our cohort the success of TVT was not significantly affected by the severity of SUI. In our cohort, low MUCP and high BMI were shown to be significant predictors of SUI severity. Nevertheless, treatment success of SUI with TVT did not differ substantially in women with more severe SUI.

A 10- to 20-year follow-up after tension-free vaginal tape for stress urinary incontinence.

Midurethral slings (MUS) have become the gold standard in the treatment of stress urinary incontinence (SUI). Some information is already available on the outcome of tension-free vaginal tape (TVT) after 10 years or more. Our objective was to assess the current outcome (efficacy, adverse events) of women who had been successfully operated upon for SUI by means of a TVT procedure 10 to 20 years ago. We performed a retrospective cohort study including 291 women (mean age 69.4 years) who underwent a successful TVT procedure (retropubic bottom-to-top route) in a teaching hospital between January 2001 and December 2010. The main outcome measure was the incidence of SUI at 10-20 years' follow-up. Others were incidence of re-operation, tape exposure and de novo overactive bladder symptoms. We carried out a univariate logistic regression analysis to examine the relationship between outcomes and a set of clinical variables. After a median of 15 years, TVT remains highly effective: 272 women (94%) experienced either no leakage under any circumstance (214=74%) or leakage less than weekly (58=20%). Mesh exposure (8=2.7%; 1.8 events per 1,000 patient-years) and repeat surgery for SUI (11=3.8%; 2.5 events per 1,000 patient-years) were low. Three women (1%) needed to perform intermittent self-catheterisation. Bothersome overactive bladder symptoms (45=15%) were common and associated with polypharmacy, cardiovascular medication and obesity. The efficacy of TVT is demonstrated up to 20 years. The presence of bothersome OAB symptoms in the population may be an indicator of multimorbidity.

The Role of Pelvic Ultrasound in Evaluating the Success of Tension-free Vaginal Tape (TVT).

This study aims to assess the lack of response to treatment in individuals undergoing mid-urethral sling surgery for stress urinary incontinence (SUI) using ultrasound findings of the pelvic floor. The study included patients who underwent the tension-free vaginal tape (TVT) procedure for stress urinary incontinence within the period spanning from January 2016 to January 2021. The physical examination involved maintaining bladder filling at an average volume of 200-400 mL, and treatment failure was determined by the presence of SUI during the Valsalva maneuver. The study comprised a total of 214 patients, where it was observed during the stress test that 32 patients (25.8%) had an unsuccessful outcome following mid-urethral sling surgery. In the unsuccessful group, the distance of the mesh-posterior urethra was lower (4.09±0.39 vs. 4.91±0.51; p<0.001), the posterior urethrovesical angle was lower when at rest, but the angle increased more significantly during the Valsalva maneuver, and the bladder neck angle was narrower (p<0.001). We obtained lower mean values of mesh-posterior urethral distance in unsuccessful patients compared to those found in the group of cured patients. Pelvic floor ultrasound can predict the success of TVT surgeries but there is as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence.

Medium Term Outcomes of TVT-Abbrevo for the Treatment of Stress Urinary Incontinence: Efficacy and Safety at 5-Year Follow-Up.

Background and objectives: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting approximately 46% of adult women. After failure of conservative treatment, the mid-urethral sling (MUS) is considered the most effective and safe surgical procedure for SUI. In 2012, Waltregny et al. introduced a new trans-obturator tension-free vaginal tape (TVT) procedure, named TVT-abbrevo (TVT-A). The aim of the present study is to evaluate the efficacy and safety of the TVT-A procedure in women with pure SUI at 5-year follow-up. Materials and Methods: All women who complained of pure SUI symptoms with concomitant urodynamic stress incontinence (USI) were prospectively enrolled and treated with the TVT-A procedure. Postoperative subjective outcome measures included: International Consultation on Incontinence Questionnaire–Short Form (ICI-Q SF), Patient Global Impression of Improvement (PGI-I) scale, and patient degree of satisfaction scale. A PGI-I score ≤ 2 and a patient-satisfaction score ≥8 were used to define subjective success. Objective success was defined as the absence of urine leakage during a cough stress test. Adverse events were collected according to the Clavien–Dindo classification during follow-up. Results: Univariable analysis was used to investigate outcomes. Fifty women who met the inclusion criteria underwent TVT-A implantation. At 5 years after TVT-A implantation, 38 out of 45 (84.4%) patients were subjectively cured (p for trend 0.05), and 40 out of 45 (88.9%) patients were objectively cured (p for trend 0.04). A significant trend of de novo OAB symptoms was reported (22.2% [10/45]) at the 5-year follow-up. No serious early or late complications such as urethral/bladder injury, persistent groin-thigh pain, and sexual dysfunction that required mesh removal were detected. The univariate analysis did not reveal any risk factors (i.e., age, body mass index (BMI), menopause, obstetric factors, and preoperative ICIQ- SF questionnaire) statistically associated with failure of the TVT-A procedure. Conclusions: In conclusion, the 5-year follow-up results of this study demonstrated that TVT-A is a safe and effective option for treatment of SUI with a very low rate of post-operative groin–thigh pain

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.

Short-Term Urinary Retention After Tension-Free Vaginal Tape Midurethral Sling Performed Alone or as a Concomitant Procedure.

The objective was to determine whether a difference exists in short-term urinary retention after tension-free vaginal tape (TVT) midurethral sling placement when performed alone compared with when placed during a concomitant prolapse procedure. We conducted a single-center retrospective cohort study that compared TVT procedures performed alone (group 1) to those with a concomitant prolapse procedure (group 2). The primary outcome was the proportion of patients discharged with an indwelling Foley catheter after failing postoperative voiding trial. There were 100 women in group 1 and 267 women in group 2. Concomitant prolapse procedures included vaginal approach (n = 47), robotic (n = 218), or both (n = 2). Forty-nine patients (13.4%) failed the initial voiding trial and 21 patients (5.7%) were discharged with an indwelling Foley catheter. The rate of short-term urinary retention requiring an indwelling catheter at discharge was not significantly different between group 1 and group 2 (9 [9.0%] vs 12 [4.5%], P = 0.1). The duration of catheterization after discharge was shorter in group 1 compared with group 2 (2.1 ± 1.1 vs 4.3 ± 2.0 days, P = 0.008). In multivariate analysis, patients discharged with a catheter were more likely to have diabetes with an odds ratio of 3.1 (95th confidence interval, 1.2-8.1). The proportion of patients discharged with an indwelling catheter did not significantly differ if TVT was performed alone or at the time of a concomitant prolapse procedure (9.0% vs 4.5%, P = 0.1).

A retrospective analysis of perioperative complications associated with retropubic tension-free vaginal tape in 960 women

PurposeThe purpose is to analyse perioperative complications associated with the retropubic tension-free vaginal tape (TVT) procedure and their management.MethodsThis retrospective, monocentric cohort study included 960 women after retropubic TVT procedure performed by one surgeon from 2011 to 2016. Complications were identified up to 6 weeks after the procedure, divided into specific and general complications and classified based on the Clavien–Dindo (CD) Classification. A visit 6 weeks after the surgical procedure was attended by all patients.Results77 complications, of which 74 occurred postoperatively and 3 intraoperatively, affecting 72 (7.5%) out of 960 women. Urinary retention and voiding problems were the most common complication. The mean age of women suffering complications was 3.4 years higher in comparison to the mean age of women without complications (p = 0.036). The Body Mass Index (BMI) of the group of women with perioperative complications had an average BMI which was 0.5 kg/m2 lower than the average BMI of the women without complications. 22 (12.8%) out of 172 women with recurrent stress incontinence had postoperative complications, of which 21 were related to the TVT.ConclusionThe retropubic TVT is a surgical procedure associated with a low number of perioperative complications, even in the group of elderly and overweight women, as well as in cases of recurrent stress incontinence.

Management and Follow-Up Practices of Women With Recurrent Stress Urinary Incontinence Following Transobturator Mid-urethral Synthetic Sling Procedure: A 6-Year Retrospective Monocentric University-Based Study.

Purpose: The purpose of this study is to evaluate the efficacy of management and follow-up practices in repeat retropubic mid-urethral synthetic sling (MUS) procedure after transobturator tape/tension-free vaginal tape-obturator (TOT/TVT-O) failure, and to clarify the possible etiology of recurrent stress urinary incontinence.Methods: The charts of all women patients who underwent tension-free vaginal tape (TVT) slings after previous failed transobturator MUS procedures between February 2012 and November 2018 at a single center were reviewed retrospectively. The transperineal ultrasound was performed to assess the pre-operative or post-operative urethral mobility and location of the slings. Furthermore, some essential evaluations were also made, mainly including medical history, physical examination, 1 h pad test, and urodynamic study. Finally, primary outcomes were evaluated according to the above items at 3, 6, and 12 months after the second operation, respectively.Results: Thirty-five patients were included in the primary transobturator MUS sling procedure. At the 6 months follow-up, 32 (91.42%) patients were socially continent and negative in 1 h pad test. The transperineal ultrasound measurement results revealed that the bladder neck descent (BND) values were significantly decreased after the repeat sling operation, and better urinary continence function was observed according to the post-operative urodynamic study. Multifactorial etiologies resulted in recurrent stress urinary incontinence (SUI), including poor surgical technique, inadequate sling tension when treating ISD, and inappropriate sling position. Then the detail of the surgical procedure varied with the results of pre-operative evaluations, affecting the validity of the second sling.Conclusion: Recurrent SUI has resulted from multi factors, pre-operative urodynamic study and transperineal ultrasound might be valuable tools to guide repeat sling operation and predict post-operative outcomes. A repeat TVT procedure may be regarded as a remedial measure for a failed transobturator MUS operation.

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.

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.

The effect of tension-free vaginal tape on coital incontinence concomitant with stress urinary incontinence.

The aim of this study was to evaluate the impact of tension-free vaginal tape (TVT) on coital incontinence concomitant with stress urinary incontinence. TVT was performed on sexually active women diagnosed with urodynamic stress incontinence (USI) who also experienced coital incontinence with penetration and/or orgasm. The patient-reported success rate was assessed by the Patient's Global Impression of Improvement (PGI-I) scale. The sexual function of the women was evaluated by the fulfilled Female Sexual Function Index (FSFI) before and after the operations. Eighty-two women underwent the TVT procedure with epidural anesthesia and 80 of them (97%) answered pre-operative and post-operative FSFI questionnaires. In the pre-operative clinical assessment, 48 women (58%) stated they experienced urinary incontinence during penetration, 13 (15%) during orgasm, and 21 (25%) identified it for both. The patient-reported success rate was 86% (71 of 82 patients) according to the PGI-I results: 44 of 48 women (91%) during penetration, nine of 13 (69%) during orgasm, and 18 of 21 (85%) for both. The FSFI scores for sexual desire, lubrication, and sexual arousal domains increased in 57 (71%), 49 (61%), and 44 (55%) patients, respectively, whereas they remained unchanged in 23 (28%), 31 (38%), and 36 (45%) patients. For the orgasm, satisfaction, and pain domains, the results were similar. The mean total FSFI score before the operations was 23.63 ± 6.84 and it significantly increased after surgery to 29.47 ± 4.28 (P < .05). The TVT procedure may offer treatment for coital incontinence accompanying USI. It also provides significant improvement in the sexual lives of women.

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.

MP30-11 LONG-TERM OUTCOMES FROM TVT PROCEDURES FOR TREATMENT OF FEMALE STRESS URINARY INCONTINENCE: DATA FROM A MINIMUM OF 18 YEARS OF FOLLOW-UP

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (MP30)1 Apr 2020MP30-11 LONG-TERM OUTCOMES FROM TVT PROCEDURES FOR TREATMENT OF FEMALE STRESS URINARY INCONTINENCE: DATA FROM A MINIMUM OF 18 YEARS OF FOLLOW-UP Phil Hyun Song*, Yeong Uk KIm, Jae Young Choi, Young Hwii Ko, Ki Hak Moon, and Hee Chang Jung Phil Hyun Song*Phil Hyun Song* More articles by this author , Yeong Uk KImYeong Uk KIm More articles by this author , Jae Young ChoiJae Young Choi More articles by this author , Young Hwii KoYoung Hwii Ko More articles by this author , Ki Hak MoonKi Hak Moon More articles by this author , and Hee Chang JungHee Chang Jung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000869.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the long-term outcomes of the tension-free vaginal tape (TVT) procedure, we investigated the data from female patients with stress urinary incontinence (SUI) who had a minimum of 18 years of follow-up to determine the predictive risk factors affecting the treatment efficacy. METHODS: A total of 191 female patients (mean ± SD age: 64.1 ± 7.1 years) who had undergone the TVT procedure for SUI were selected and followed-up for at least 18 years (mean ± SD duration: 227.4 months, range: 223-232 months). We analyzed the long-term results and the predictive parameters for success rates, and patients’ satisfaction. RESULTS: At 18 years after surgery, the overall cure rate was 84.6%, with a satisfaction rate of 69.4%. Univariate analysis showed an association between the SUI symptom grade and the cure rates, while the presence of frequency, urgency, and urge incontinence showed an association with the patients’ satisfaction. However, in the multivariate logistic regression model, none of these variables were identified as an independent risk factor related to the cure and satisfaction rates. Twenty patients (10.0%) had postoperative complications at 1 year after surgery. However, at 18-years after surgery, only 2 patients (1.0%) had a postoperative complication, such as de novo urgency. CONCLUSIONS: Our long-term data show that the TVT procedure is a reliable method for the treatment of female SUI, regardless of any independent predictive factors. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e442-e442 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phil Hyun Song* More articles by this author Yeong Uk KIm More articles by this author Jae Young Choi More articles by this author Young Hwii Ko More articles by this author Ki Hak Moon More articles by this author Hee Chang Jung More articles by this author Expand All Advertisement PDF downloadLoading ...

Case report of sigmoid colon perforation and colocutaneous fistula due to retropubic midurethral sling placement for stress urinary incontinence

BackgroundSigmoid bowel perforation is a very rare and serious complication of the retropubic tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. The complication can be avoided with the use of the correct manipulation technique.Case presentationA 75-year-old female patient underwent a retropubic TVT procedure in the local hospital for the treatment of stress urinary incontinence. The procedure was smooth. Two weeks after surgery, the patient began to complain of fever and bloody, purulent discharge from the left suprapubic skin wound. During a 4-month period after surgery, she was admitted to the local hospital 4 times for similar infection symptoms. The infections were temporarily controlled with antibiotic administration. The reason for the refractory infection of the left suprapubic skin wound was not identified until a foreign TVT mesh was found in the sigmoid colon via a colonoscopy. We diagnosed that the TVT mesh caused a sigmoid colon perforation that led to colocutaneous fistula. An exploratory laparotomy revealed that the TVT tape perforated into and out of the sigmoid colon. An 8-cm long left part of mesh was removed. Two ruptures of sigmoid colon were mended without the need for bowel resection. At the 4-years follow-up after laparotomy, the patient was doing well and still continent.ConclusionsUrologists and gynecologists should be aware of the possibility of colon bowel injury in SUI patients with prior sling surgeries. Patient having recurrent suprapubic cutaneous infection may have high degree of suspicion of colon injury after TVT sling. The passage of the retropubic space procedure should be slow and always along the pubic bone according to the anatomy.