Tension-free Vaginal Tape Operation Research Articles

1028 - Success and satisfaction of tension-free vaginal tape surgery in females with stress urinary incontinence: Results at 17 years of follow-up

1028 - Success and satisfaction of tension-free vaginal tape surgery in females with stress urinary incontinence: Results at 17 years of follow-up

Heterogeneity of cost estimates in health economic evaluation research. A systematic review of stress urinary incontinence studies

Introduction and hypothesisThere is increased demand for an international overview of cost estimates and insight into the variation affecting these estimates. Understanding of these costs is useful for cost-effectiveness analysis (CEA) research into new treatment modalities and for clinical guideline development.MethodsA systematic search was conducted in Ovid MEDLINE & other non-indexed materials and Ovid Embase for articles published between 1995 and 2017. The National Health Service Economic Evaluation Database (NHS-EED) filter and the McMaster sensitive therapy filter were combined with a bespoke search strategy for stress urinary incontinence (SUI). We extracted unit cost estimates, assessed variability and methodology, and determined transferability.ResultsWe included 37 studies in this review. Four hundred and eighty-two cost estimates from 13 countries worldwide were extracted. Descriptive analysis shows that hospital stay in gynecology ranged between €82 and €1,292 per day. Costs of gynecological consultation range from €30 in France to €158 in Sweden. In the UK, costs are estimated at €228 per hour. Costs of a tension-free vaginal tape (TVT) device range from €431 in Finland to €994 in Canada. TVT surgery per minute costs €25 in France and €82 in Sweden. Total costs of TVT range from €1,224 in Ireland to €5,809 for inpatient care in France. Variation was explored.ConclusionsHeterogeneity was observed in cost estimates for all units at all levels of health care. CEAs of SUI interventions cannot be interpreted without bias when the base of these analyses—namely costs—cannot be compared and generalized.

Effectiveness and Complications of TVT and TVT - O Operations in the Treatment of Female Stress Urinary Incontinence. Five Years Follow - Up Prospective Study

The Aim of the Study: To compare TVT (tension - free vaginal tape) and TVT - O (tension - free vaginal tape obturator) operations: results, complications, effectiveness after 5 years of follow - up. Material and M ethods: A single center nonblind, prospective study of women with SUI who were randomized to TVT and TVT - O from April 2005 to April 2013. Prospective study out of 394 patients, 114 were operated using TVT operation and 280 patients – TVT - O operation. There was no significant difference between groups concerning the age, BMI (body mass index), parity, menopausal status and prolapse (no patients had cystocele greater than stage II). Results: Mean operat ive time was significantly shorter in the TVT - O group (18±4.6 min) compared with the TVT group (27±7.1 min). There were no significant differences in the effectiveness of both procedures after 5 years. Hospital stay was statistically significantly shorter in TVT - O group (1.2±0.5 days) than in TVT group (4.0±0.6 days). Significantly less complication were in TVT - O group. Conclusion: TVT and TVT - O operations are equally effective for the surgical treatment of female stress urinary incontinence. TVT - O had a sh orter operation time and a lower complication rate.

Comparison between tension-free vaginal tape and transobturator tape in treating stress urinary incontinence after vaginal mesh surgery

ObjectiveA midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients. Materials and MethodsWe enrolled patients who had symptomatic SUI after anterior vaginal mesh repair who underwent either TVT or TOT surgery. Successfully cure was defined as the absence of urinary leakage in a stress test during filling cystometry, and a negative cough test. Quality of life was evaluated using the short form of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). ResultsWe included 50 patients in the TOT group and 37 patients in the TVT group, with a median follow-up of 18.5 months. The TVT group had a significantly higher success rate than the TOT group (88% vs. 60%, p = 0.036), while there was no statistically significant difference in de novo detrusor overactivity (30% vs. 9%, p = 0.090). There was also no significant difference in postoperative quality of life (UDI-6, 5.9 ± 7.9 vs. 5.0 ± 5.9, p = 0.639; IIQ-7, 5.2 ± 12.5 vs. 4.3 ± 9.7, p = 0.766). The TVT group had a longer operative time (p < 0.001) and hospital stay (p = 0.004), however the TOT group required more repeat surgeries for recurrent SUI (p = 0.045). ConclusionRetropubic TVT is a more effective surgical option than TOT in women with SUI after vaginal mesh repair.

Patient goal achievement 2 years after a tension-free vaginal tape operation.

The primary aim of this study was to investigate long-term patient-reported goals after a tension-free vaginal tape (TVT) operation for stress urinary incontinence (SUI). In this prospective study involving 67 women, patients completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) preoperatively and stated three goals for the operation. Postoperatively, a visual analog scale (VAS) ranging from zero (none) to ten (worst) estimated the extent to which goals were achieved. Goals were divided into five groups: symptoms, quality of life (QoL) (physical), QoL (emotional), sexual function, avoidance, and others. Short-term achievement of goal was estimated after 3months and long-term achievement of goals after a mean of 28.2months. A total of 201 goals were stated, most of which (38%) were in the group concerning QoL in physical domains. Mean VAS score for all goals was 9.1 after 3months and 8.5 at long-term follow-up. ICIQ-UI SF preoperatively was mean 14.9; 3months' postoperatively mean 1.4; and at long-term 3.8. The small rise in ICIQ-UI SF at long-term follow-up was statistically insignificant and due to urge urinary incontinence (UUI). Our study showed that patients achieved their goals to a high degree and maintained them at long-term follow-up. Most goals concerned QoL in physical domains. Although a proportion of women experienced episodes of UUI at the long-term follow-up, VAS score was not significantly changed.

Can We Predict De Novo Urge Incontinence by Perineal Ultrasound?

Introduction: Urinary incontinence affects over 200 million people worldwide [1]. Tension free vaginal tape is the standard surgical treatment for stress urinary incontinence. De novo urge urinary incontinence is a long-term complication of this treatment with a significant impact in the quality of life of these patients. Objective: The major aim of this study is to assess the correlation between perineal ultrasonography findings and the incidence of de novo urge urinary incontinence. Material and Methods: A prospective observational study was designed. Patients with stress urinary incontinence diagnosed by clinical and urodynamic findings submitted to a tension-free vaginal tape surgery were included. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and introital perineal ultrasound were performed before surgical intervention (I-STOP&copy). Clinical and ultrasound re-evaluation were executed six months after surgery. Stress urinary incontinence was defined according to the ICS-IUGA. Data were recorded using a Microsoft Access database and statistical analysis using SAS&copy. Results: Bladder thickness equal to or below 6 mm has a low positive predictive value (PPV, 0.55), but a negative predictive power (NPP) of 0.72. Following surgery, a slight increase in postvoid residue is observed. Considering demographic data, an increase of 5 points in body mass index (BMI) resulted in an odds ratio (OR) of 1.74 of presenting de novo urge urinary in continence. Conclusions: In patients submitted to a tension-free vaginal tape surgery, high BMI seems to be associated with a higher rate of de novo urge urinary incontinence. Preoperative bladder wall thickness below 6 mm seems predict absence of this complication.

Long-term clinical outcomes with the retropubic tension-free vaginal tape (TVT) procedure compared to Burch colposuspension for correcting stress urinary incontinence (SUI)

The retropubic tension-free vaginal tape (TVT) procedure replaced Burch colposuspension as the primary surgical method for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) in women in our department in 1998. In this study we compared the short-term and long-term clinical outcomes of these surgical procedures. Using a case series design, we compared the last 5years of the Burch procedure (n=127, 1994-1999) with the first 5years of the retropubic TVT procedure (n=180, 1998-2002). Information from the medical records was transferred to a case report form comprising data on perioperative and long-term complications as well as recurrence of UI, defined as bothersome UI or UI in need of repeat surgery. Other endpoints were rates of perioperative and late complications and the rates of prolapse surgery after primary surgery. The data were analyzed with the chi-squared and t tests and survival analysis using SPSS. The cumulative recurrence rate of SUI in women with preoperative SUI was significantly higher after the Burch procedure, but no difference was observed in women with MUI. There were no significant differences in rates of perioperative and late complications. At 12years there was a significant increase in rates of repeat surgery for incontinence and prolapse in women after the Burch procedure. The long-term efficacy of TVT surgery was superior to that of Burch colposuspension in women with SUI. In addition, the rate of late prolapse surgery was significantly higher after the Burch procedure.

Long-term Follow-up of Sexual Function in Women Before and After Tension-Free Vaginal Tape Operation for Stress Urinary Incontinence

(Abstracted from Int Urogynecol J 2016;27:1571–1576) A number of studies have investigated the effect of incontinence surgery on sexual function in women. Results have been conflicting; some studies have reported improvement, some deterioration, and others no difference.

A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence

There is little data comparing the surgical outcomes of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in obese women. Therefore, we aimed to compare the surgical outcomes of TOT and TVT procedures among obese women with a diagnosis of stress urinary incontinence (SUI). One hundred and eighty-nine women who underwent TVT or TOT procedures due to pure SUI were included. Women in whom the body mass index (BMI) was ≥30 kg/m2 were considered as obese, while <30 kg/m2 were non-obese. And women with BMI ≥35 kg/m2 was defined as morbidly obese. At sixth month postoperative follow-up, neither the comparison of TVT and TOT results in obese women nor the comparison of TVT or TOT results between obese and non-obese women showed any significant differences in terms of objective and subjective cure rates, quality of life improvements, or intra/postoperative complications. TVT and TOT procedures also have similar effectiveness among morbidly obese women. We have concluded that TVT and TOT operations seem to be equally effective and safe surgical treatment procedures for female SUI regardless of BMI.

The Role of Obesity in Success and Complications in Patients Undergoing Retropubic Tension-Free Vaginal Tape Surgery

The Role of Obesity in Success and Complications in Patients Undergoing Retropubic Tension-Free Vaginal Tape Surgery

Fulfilment of patient goals after tension-free vaginal tape operation for stress urinary incontinence.

The aim of this study was to investigate patient-reported goals after a tension-free vaginal tape operation for stress urinary incontinence and the correlation with postoperative incontinence. A prospective study involving 70 women was carried out. Preoperatively, patients completed the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and stated three goals for the operation. A telephone interview was performed 3months postoperatively. A Visual Analogue Scale (VAS) score from zero to ten estimated the extent to which goals were achieved. Goals were divided into five groups: 1, symptoms; 2, quality of life (physical); 3, quality of life (emotional); 4, sexual function; 5, avoidance. ICIQ-UI SF preoperative mean was 14.9 and postoperative mean was 1.5 (p < 0.05). A total of 210 goals were stated. The majority of the goals (38%) were in group 2 concerning quality of life in the physical domains. Mean VAS score for all goals was 9.1 (SD 2). Thirty-seven patients (53%) fulfilled all their goals. Twenty-one patients (30%) did not have a VAS score of 10, although continent with an ICIQ-UI SF score of zero. Reasons for not achieving a full VAS score were that some still used pads out of fear (n = 10), that their mental focus was still on incontinence (n = 7) or that they had not yet tried some of the physical aims (n = 7). Most patients achieved their goals. The majority of the goals concerned quality of life in the physical domains.

The Role of Obesity in Success and Complications in Patients Undergoing Retropubic Tension-Free Vaginal Tape Surgery.

The aim of this study was to examine the impact of obesity on the success rate of and complications from retropubic tension-free vaginal tape (TVT) midurethral slings for stress urinary incontinence (SUI). A retrospective, cohort study was performed on patients with retropubic TVT surgery between 2008 and 2014. Demographic, outcome, and complication data were obtained from electronic medical records and analyzed using logistic regression, analysis of variance, and multivariate regression analysis. Short-term (1-2 weeks) and long-term (2 months) outcomes were measured. Two hundred twenty-seven patients were included; 100 (44%) were of normal weight, 71 (31%) were overweight, and 56 (24%) were obese. Overall SUI cure rates were high, although the obese group had a lower cure rate. Compared with normal weight, overweight patients had a 2.43 times higher odds (P = 0.14) of short-term complaints of persistent SUI, whereas obese patients had a 3.56 times higher odds (P = 0.03). Similar failure rates were seen at 2 months among the groups. Odds of intraoperative complications did not differ between overweight and normal weight (odds ratio [OR], 0.64; P = 0.319) and obese and normal weight (OR, 0.90; P = 0.83) patients. Postoperative complications did not differ between overweight and normal weight (OR, 0.40; P = 0.27) and obese and normal weight (OR, 1.45; P = 0.54) patients. Obese women undergoing retropubic TVT surgery had a 3.56 increased odds of short-term complaints of SUI compared with normal weight patients, but 2-month failure rates were similar. Obese and overweight patients were equally likely to have complications from TVT.

Long-term follow-up of sexual function in women before and after tension-free vaginal tape operation for stress urinary incontinence.

This prospective study investigates sexual function in women after a tension-free vaginal tape (TVT) operation and compares short-term and long-term effects. Sixty-three women had a TVT operation performed at Aalborg University Hospital, Department of Gynecology and Obstetrics, between November 2008 and June 2010. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 6months postoperatively, and at the long-term follow-up (mean 4years and 9months). Forty-four women completed the two questionnaires all three times. Preoperatively, mean PISQ-12 was 33.8 [95% confidence interval (CI) 28.9-38.6] and the ICIQ-UI SF was 15.2 (14.4-16.0). Postoperatively the PISQ-12 increased significantly and the ICIQ-UI-SF decreased significantly, to 36.7 (31.5-41.9) and 2.5 (1.3-3.8), respectively, at the 6-months follow-up and 35.8 (33.6-38.1) and 4.9 (3.4-6.3), respectively, at the long-term follow-up. The greates improvement was in the physical domain of the PISQ-12. Women experienced less negative emotional reactions during intercourse, less coital incontinence, and less fear of being incontinent during intercourse after the TVT operation. This study shows that a woman's sex life does not deteriorate after a TVT operation, that their sexual function improves somewhat, and that results are sustained over time.

Long-Term Outcome of the Pippi Salle Procedure for Intractable Urinary Incontinence in Patients with Severe Intrinsic Urethral Sphincter Deficiency

We evaluated the long-term outcome of the Pippi Salle procedure in patients with severe intrinsic urethral sphincter deficiency. We performed the Pippi Salle procedure in 6 males and 6 females with severe intrinsic sphincter deficiency between March 2003 and August 2013. Median patient age was 15 years (range 6 to 45). Mean followup was 75 months (range 17 to 142). Six males and 3 females had neurogenic intrinsic sphincter deficiency (spina bifida in 8 and spinal cord injury in 1). Three females had anatomical intrinsic sphincter deficiency (idiopathic bladder hypoplasia in 2 and pseudo-ureterocele in 1). Four patients had previously undergone bladder neck surgery, 3 had been treated with endoscopic injection of collagen, 2had undergone fascial sling and 1 had been treated with tension-free vaginal tape surgery. The Pippi Salle procedure was performed alone (2 patients), or in combination with bladder augmentation (4) or catheterizable abdominal stoma (1), or both (5). Complete dryness was achieved in 7 patients (58%). Of 9 patients with neurogenic intrinsic sphincter deficiency 7 (78%) achieved complete dryness. Eight patients experienced complications, including continued urinary incontinence (5), difficulty catheterizing per urethra (3) and urinary calculi (1). These 8patients were successfully treated with additional endoscopic interventions, including injection of collagen in 4, injection of dextranomer-hyaluronic acid in 1,transurethral incision of urethral kink in 3 and vesicolithotripsy in 1. After these simple interventions complete dryness was achieved in all 12 patients. Although we experienced some minor complications in the short term, most patients were simply and successfully treated with endoscopic surgery. The long-term results of the Pippi Salle procedure are promising.

Comparing Trans Obturator Tension Free Vaginal Tape Surgery with Needleless Suburethral Sling

Comparing Trans Obturator Tension Free Vaginal Tape Surgery with Needleless Suburethral Sling

Transobturator tension-free vaginal tape is the most common procedure in women with stress urinary incontinence: our experience

Transobturator tension-free vaginal tape (TVT-O) surgery is currently one of the most effective procedures used to treat women with stress urinary incontinence (SUI), however, long-term follow-up data in medical literature is scarce. For this study, we enrolled women with SUI assessed by an urodynamic examination and a translabial ultrasound with a pelvic organ prolapse no greater than grade 2. All of the women were also given a pre- and postoperative test to assess their quality of life. They were given a thorough physical examination, asked to keep a voiding diary, and underwent an urodynamic examination and a translabial ultrasound. Additionally, we also further evaluated intraoperative and postoperative complications and the onset of &lt;em&gt;de novo&lt;/em&gt; detrusor overactivity after the procedure. We also assessed the long-term efficacy of the TVT-O in those women with SUI caused by sphincter hypotonia. All of the women underwent TVT-O surgery without any associated procedure. Our findings indicate that TVT-O surgery is an effective treatment option for women with SUI, showing a very high cure rate and a low incidence of complications, with sustained outcomes even in the long-term. However, in women with SUI caused by sphincter hypotonia, the excellent outcomes in early stages tend to dwindle over time

Risk Factors for Long-term Failure of the Retropubic Tension-Free Vaginal Tape Procedure

The development of minimally invasive techniques to restore continence in women with stress urinary incontinence (SUI) led to the introduction of the retropubic tension-free vaginal tape (TVT) procedure in 1996. A number of studies have demonstrated promising long-term results after use of retropubic TVT. The largest long-term follow-up study to date was published in 2013 by the authors of the present study. Data from that study showed excellent long-term outcomes with low 10-year subjective and objective failure rates. The aim of this study was to identify potential risk factors of long-term (10-year) subjective and objective failure after the retropubic TVT procedure. A secondary risk analysis was performed merging 10-year outcome data from the 2013 study with additional preoperative and operative information individually stored in the Norwegian Female Incontinence Registry. Data were obtained on potential risk factors of subjective failure 10 years after TVT from 483 women with the use of a validated questionnaire. Data on potential risk factors of objective failure at 10 years were obtained from 327 women with the use of a standardized stress test. Logistic regression analyses were used to assess preoperative and operative data stored in the Norwegian Female Incontinence Registry. Subjective failure was defined as the percentage of women reporting that they were not cured. Objective failure was defined as urinary leakage of 1 g or greater during a standardized in-office stress test. The median time to follow-up was 129 months, and the median age at the time of surgery was 54 years (range, 26–87 years). Age of 56 years or older at the time of surgery was an independent risk factor of both long-term subjective (adjusted odds ratio [aOR], 2.15; 95% confidence interval [CI], 1.40–3.30) and objective failure (aOR, 2.81; 95% CI, 1.30–6.09). There was a significant risk for long-term subjective but not objective failure in women with mixed incontinence who had severe urinary incontinence symptoms; the aOR was 2.33, with a 95% CI of 1.27 to 4.28. In univariate analysis, surgical complications during or immediately after surgery were associated with both subjective and objective failure, but in multivariate analysis, surgical complications were an independent risk factor of only subjective failure (aOR, 3.02; 95% CI, 1.53–5.95). These data show that age of 56 years or older, severe preoperative urgency incontinence symptoms, and surgical complications are independent risk factors of long-term (10-year) failure after TVT surgery.

Sexual function in women before and after tension-free vaginal tape operation for stress urinary incontinence.

To evaluate sexual function in women before and after tension-free vaginal tape operation for stress urinary incontinence. Prospective study. Aalborg University Hospital, Department of Gynecology and Obstetrics between November 2008 and June 2010. Sixty-three women who had a tension-free vaginal tape operation performed. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 6 months postoperatively. Differences in PISQ-12 measures 6 months after the tension-free vaginal tape operation. Twelve women were excluded because of non-completed questionnaires. Preoperatively the PISQ-12 score was 33.7 and postoperatively 36.7, giving a significant difference of 3.0 (p < 0.05). Forty women (78%) scored higher postoperatively, five (10%) scored the same and six (12%) reported lower scores postoperatively. Only PISQ-12 questions in the physical domain were significantly improved. These values were elevated close to the maximum score. Preoperatively 18 women (35%) experienced coital incontinence always, often or sometimes. Postoperatively this was only the case in two women. Most women experience an improvement in sexual life after a tension-free vaginal tape procedure mainly because of absence of incontinence during sexual activity or absence of fear of incontinence during sexual activity.

Treatment of recurrent stress urinary incontinence in women: comparison of treatment results for different surgical techniques.

IntroductionThere is still no consensus on which surgical technique is the most effective for female recurrent stress urinary incontinence after the initial surgery.AimTo compare the long-term treatment outcomes of Burch colposuspension operation, transobturator tape implantation (TOT) and tension-free vaginal tape (TVT) procedures performed for female recurrent stress urinary incontinence after the initial surgery.Material and methodsA retrospective study was performed on 45 women operated on for recurrent stress urinary incontinence after the initial surgery. Depending on the surgical approach, the patients were divided into three groups: group I (n = 19) – Burch colposuspension operation, group II (n = 16) – TOT, and group III (n = 10) – TVT operation was performed. The treatment results were assessed using the UDI-6 (Urogenital Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) short form questionnaires. We included one additional question: Is the patient satisfied with the treatment outcome? We classified the urinary continence results after surgery as good when patients were cured or improved, and as bad when the treatment failed.ResultsGood urinary continence results were observed in 84.2% of patients in group I, 93.8% of patients in group II, and 90% of patients in group III. 68.4% of patients in group I, 81.3% of patients in group II, and 90% of patients in group III were satisfied with the treatment outcomes.ConclusionsBurch colposuspension operation, TOT and TVT procedures performed for the female recurrent stress urinary incontinence treatment are effective and show similar good urinary continence results and similar number of patients satisfied with the treatment outcomes.

Coronary vasospasm caused by local infiltration of epinephrine after spinal anesthesia.

Coronary vasospasm caused by local infiltration of epinephrine after spinal anesthesia.