Tension-free Vaginal Tape Technique Research Articles

Fabrication and in vitro investigation of hyperbranched poly-lysine-grafted warp knitted polypropylene sling for potential treatment of stress urinary incontinence.

Polypropylene (PP) sling implantation is the most commonly performed procedure for women with stress urinary incontinence (SUI). However, concerns have arisen regarding complications caused by slings, including the common issue of erosion, which can be attributed to various factors such as the body's response and bacterial contamination. To address these concerns, we have developed a rectangular mesh self-locking edge sling with a large pore size and lightweight design. Promising results have been obtained from preliminary in vivo mechanical reliability tests, including uniaxial tensile tests. In comparative in vitro fixed load tensile tests and simulated Tension-free Vaginal Tape (TVT) and Transobturator Vaginal Tape inside-out (TVT-O) technique tests using commercial slings, our sling demonstrated less transverse wrinkling. Both slings achieved an effective porosity of over 45% under the TVT technique. However, the commercial sling experienced a significant reduction in effective porosity during the TVT-O technique, whereas our sling maintained a stable effective porosity with minimal wrinkling. Furthermore, we successfully developed cationic hydration rejection-driven antibacterial-anti-fouling coatings on the surface of our sling by grafting hyperbranched poly-lysine (HBPL) mediated by polynorepinephrine. The HBPL coating imparts a positive charge and hydrophilicity to the sling, resulting in elevated bactericidal activity and reducing protein adhesion. An optimal grafting concentration of 20 mg mL-1 was selected, confirming the stability and biocompatibility of the sling coating. This coating is expected to reduce the likelihood of postoperative erosion. Overall, our research represents significant advancements in improving the safety and performance of PP slings for stress urinary incontinence, potentially leading to a reduction in complications following surgery.

Étude comparative entre deux procédures de mise en place d’une bandelette sous-urétrale rétropubienne TVT dans le traitement de l’incontinence urinaire d’effort féminine

To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (P<0.05), those of reoperations for pulling the sling downward 11.1% and 1.5% (P<0.05). A 1 year and more, healing and satisfaction rates were respectively 83.3% and 79.2% for the standard TVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (P<0.05). By modifying the placement of the classic TVT, it is possible to reduce its complications while maintaining its efficacy.

Randomized controlled trial of cough test versus no cough test in the tension-free vaginal tape procedure: effect upon voiding dysfunction and 12-month efficacy

This is a prospective randomized controlled trial of cough versus no cough test in the tension-free vaginal tape (TVT) procedure to determine its effect upon voiding dysfunction and 12-month efficacy. The trial was conducted in a single tertiary urogynecology unit. Women ≥21 years old with primary urodynamic stress incontinence without voiding dysfunction were considered eligible. Participants were randomized to undergo the TVT procedure using either an intraoperative cough test or using no intraoperative cough test. Our hypothesis was that postoperative voiding dysfunction would be more common in the "no cough test" arm. The primary outcome was proportion of patients successfully completing a trial of void (TOV) within 24 h of catheter removal. Efficacy at 12 months comprised the secondary outcome. Participants were randomized using a computer-generated randomization sequence by an independent party who was not the operating surgeon. Due to the nature of the intervention to be tested, neither the patients nor the operating surgeons were blinded to the randomization process during the procedure. This trial is reported according to the recommendations of the 2010 CONSORT statement. In total, 94 women were recruited over a 4-year study period. Of these, 92 women were randomized (47 in the "cough" group and 45 in the "no cough" group). In one case, the TVT procedure was abandoned intraoperatively, leaving 91 women who underwent analysis. There was no significant difference in the proportion of women with a successful TOV within 24 h between the two arms (79% in the "cough" group versus 71% in the "no cough" group; p = 0.47). Efficacy data at 12 months were not significantly different between groups. Our data suggest that the performance of the intraoperative cough test during the TVT procedure does not reduce the incidence of postoperative voiding dysfunction (as determined by successful TOV within 24 h) nor affect efficacy. The removal of the cough test from the standard TVT technique may be appropriate.

Surgical therapies of female stress urinary incontinence: experience in 228 cases

The objective of this study is to compare the efficacy and safety of tension-free vaginal tape (TVT) with Marshall-Marchetti-Krantz (MMK) procedure in stress urinary incontinence (SUI) treatment. Two hundred twenty-eight patients were enrolled in this study. TVT procedure was performed in 105 cases, MMK procedure was performed in 81 cases, Chi-square test was used, and P < 0.01 was considered statistically significant. The short-term success rate was about 89% in MMK group. However, the success rate fell to 68.2% at 5 years and 32% at 10 years. The short-term cure rate of TVT procedure was about 90.0%, and the 5-year cure rate was 84.3%. The short-term cure rate in both groups was similar, but the long-term success rate of the MMK procedure decreased sharply with time. The TVT technique provides long-term cure rates of over 84% with minimal complications. Patients who underwent TVT experienced shorter operation time, less blood loss, and less hospital stay.

Why pelvic floor surgeons should utilize ultrasound imaging

Why pelvic floor surgeons should utilize ultrasound imaging

Tension-free vaginal tape procedure and laparoscopic colposuspension in the treatment of stress urinary incontinence.

Within the last decade we have seen substantial development in the surgical techniques used to treat female stress urinary incontinence. The laparoscopic approach became available and even less invasive methods like the tension-free vaginal tape procedure were introduced. These procedures offer quicker recovery and faster return to normal activities after surgery compared with the older procedures. The tension-free vaginal tape technique has been extensively studied and clinical data from a significant number of prospective observational cohort studies have been published. The number of reports on laparoscopic incontinence surgery is more limited. Long-term follow-up results with reassuring cure rates at 5 and 7 years are available for the tension-free vaginal tape procedure. Three-year follow-up results for the laparoscopic colposuspension procedure show reasonable cure rates, though not as good as those reported for the open colposuspension, the 'gold standard'. Both of these techniques are now widely used in everyday clinical practice. Perioperative and immediate postoperative complication rates are low and acceptable. However, data are limited in terms of randomized clinical trials comparing these fairly new techniques. This review attempts to highlight the recent clinical experience of these two surgical techniques, including cure rates, complications and cost-effectiveness.

Tension-Free Vaginal Tape and Female Stress Incontinence: Further Evidence of Effectiveness

Objectives: Female stress incontinence is a frequent and distressing event with subsequent impact on quality of life. The tension-free vaginal tape (TVT) technique is considered to fulfill the criteria for an ideal surgical procedure and we therefore reviewed our cases to further analyze its effectiveness. Materials and Methods: 57 patients suffering from stress incontinence with grade 1–2 cystocele underwent the TVT operation. During follow-up (mean 22.2 months), the short- and long-term results were investigated. Results: 91.3% of patients achieved complete resolution of previous stress incontinence in the early postoperative period. Early complications occurred in 8.7% of patients. Follow-up (mean 22.2 months) highlighted the stabilization of positive outcomes in 87.7% of cases. No postoperative modification of sexual habits and a significant improvement in quality of life were reported by all patients. Conclusion: The results of our study confirm that the TVT technique for stress incontinence is an easy to perform procedure which is safe, effective and long-lasting.

Results of tension-free vaginal tape in patients with or without LAVH

Objective. To assess complication and cure rate of tensionfree vaginal tape (TVT) procedure performed with or without LAVH. Desigrz. Retrospective comparison of 30 women with urinary incontinence treated by a TVT procedure alone and 50 combined with LAVH. Results. The two groups were similar in age, parity, menopausal status and type and sererity of incontinence. There no difference in overall complication rate. In the TVThysterectomy group, there was pc (p=0.04). The mean follow-up was similar: 12 and 15 months, respectively. No difference in objective and subjective cure rates was found between TVT group and TVT-LHVH group. Corzclusiorz. TVT is a safe and effective surgical treatment of urinary incontinence. The association of the procedure with LAVH gave similar short-term objective and subjective cure rates than TVT technique alone.

Results of the tension-free vaginal tape technique in the elderly.

To assess the results of the Tension-Free Vaginal Tape (TVT) technique for the treatment of stress urinary incontinence (SUI) in the elderly. Between March 1998 and February 2001, 76 consecutive women more than 70 years old (median 76) and presenting with SUI were operated with the TVT technique. 28.9% (22/76) of the patients had previous surgery for SUI. 31% (24/76) of the patients had an overactive bladder and 4 patients had detrusor instability controlled by anticholinergic therapy. All patients had preoperative multichanel urodynamic evaluation. No serious complication was noted intra- or postoperatively. At a mean follow up of 24.6 months (range 16-49 months), 67% of the patients were cured (51/76). Among the failures, 10 patients (13.7%) had persistent SUI, 14 patients (18.4%) had urge incontinence and 2 patients were lost to follow up. De novo urgency without incontinence was noticed in 21% of the patients but preoperative urgency symptoms were cured in 46% of the patients. Overall 82% of the patients were satisfied with the result of the surgery, 14% considered the result as incomplete and 4% considered they were worsened by surgery. The TVT procedure is safe and efficient to treat SUI in the elderly population even if the rate of de novo urgency appeared to be significant.

Results of tension-free vaginal tape in patients with or without vaginal hysterectomy

Objective: To assess complications and cure rates of tension-free vaginal tape (TVT) procedure performed with or without vaginal hysterectomy. Study design: Retrospective comparison of 41 women with urinary incontinence treated by a TVT procedure alone and 40 combined with vaginal hysterectomy. Objective cure was evaluated by clinical and urodynamic examination and by the contilife questionnaire. All patients were operated under regional anesthesia. Results: The two groups were similar in age, parity, menopausal status and type and severity of incontinence. There was no difference in overall complication rates. In the TVT-hysterectomy group, there was a trend towards more bladder perforation ( P=0.09). Post-operative urinary flow was lower in the TVT-hysterectomy group: 14 versus 24 ml/pc ( P=0.02). The mean follow-up was similar: 23 and 25 months, respectively. No difference in objective and subjective cure rates was found between TVT group and TVT-hysterectomy group: 97.6% versus 92.5% and 68.3% versus 75%, respectively. Conclusion: TVT is a safe and effective surgical treatment of urinary incontinence. The association of the procedure with vaginal hysterectomy gave similar short-term objective and subjective cure rates than TVT technique alone.

URETHRAL EROSION OF TENSION-FREE VAGINAL TAPE

Stress urinary incontinence is a devastating condition that affects 10% to 20% of females in the general population.1 Different surgical procedures have been described to restore continence. Recently a new tension-free vaginal tape technique was proposed to restore urethral support by polypropylene sling placement at the level of the mid urethra. We report on a patient with severe complications after the tension-free vaginal tape procedure: Bladder outlet obstruction with detrusor instability was followed by transurethral migration of the polypropylene sling. CASE REPORT

The basic understanding and clinical results of tension-free vaginal tape for stress urinary incontinence.

Since 1994, over 100,000 surgical reconstructions of the female lower urinary tract have been performed worldwide using tension-free vaginal tape (TVT). This technique, which differs from traditional methods, is effective against symptoms of stress urinary incontinence and may be performed as an ambulatory procedure with no need of indwelling catheterization. The primary indication is genuine stress incontinence, but it is also effective as a secondary procedure for relapse after other anti-incontinence measures such as the Burch procedure. The TVT operation was developed according to study results on the mechanisms of urethral closure in women and has become the primary surgical procedure at several Scandinavian clinics for combating genuine stress incontinence in women. It is also useful in reducing symptoms after prolapse repair for combined prolapse and stress incontinence and in cases of mixed stress and urge ("sensory") incontinence. The small incisions and canals involved with the TVT technique minimize surgical trauma and enable it to be performed under local anesthesia. By the same token, it makes fairly small demands on postoperative care and attendant costs. Here we describe the instrumentation, procedure, and risks of this minimally invasive operative technique.

Tension-free vaginal tape evaluated using patient self-reports and urodynamic testing--a two-year follow-up.

Urinary incontinence entails both reduced quality of life for many women and considerable public expense. Compared with other methods aimed at alleviating incontinence, tension-free vaginal tape (TVT) is minimally invasive, can be performed under local anaesthesia and results in less morbidity and shorter hospitalization. The present study was carried out to evaluate early and late complications and as a 2-year follow-up after surgery. In 1996-98, 75 women underwent TVT sling plasty; mean time for surgery was 39 min and for hospitalization 24 h. The procedure caused bladder perforation in 3 women, but this was detected by cystoscopy and immediately corrected. Postoperative retention occurred in 9 patients but was transient. After surgery 80% were cured, 9% showed improvement and 11% were failures. Two women exhibited vaginal erosion, and one of these had previously undergone radiation therapy. One sling caused obstruction and had to be cut. Improvements included less impact on social and physical activities and mental status and significant reduction of voiding frequency, leakage episodes and pad use. The TVT technique seems to provide results comparable with those obtained with Burch colposuspension, but it entails less risk of obstruction than previous slings techniques because it causes no compression of the urethra. TVT is effective in women with genuine stress incontinence due to urethral hypermobility and in elderly women with sphincter incompetence, although the outcome is better in the former.