Tension-free Vaginal Tape Research Articles

A retrospective evaluation after insertion of the MicroGYNious single incision sling in cases of stress urinary incontinence

In the literature the rate of stress incontinence is reported between 29-75%. Compared to the established tension free vaginal tapes, the question arises, whether stabilization of the urethra can also be achieved by minimally invasive single incision slings. The aim of this retrospective analysis is to evaluate the cure rate after insertion of MicroGYNious sling. The study was carried out on 115 patients, who received a MicroGYNious sling. It was used both as a single operation for stress urinary incontinence and as a combined procedure. The degree of incontinence preoperatively and continence rate postoperatively with follow-ups (6 weeks, 6 months, one year, two years and three years) were recorded. Due to a high number of lost to follow-up after one year, only the data up to one year postoperative were included in the analysis. Preoperatively, grade I incontinence was found in 6.1%, grade II 35.7%, grade III 58.3% of the operated women. The continence rate was 96.7% postoperatively, 90 % after 6 weeks, 87.2 % after 6 months, 86.7% after one year. In terms of continence rates, the MicroGYNious sling shows similar results compared to the established procedures. Therefore, this sling provides a good treatment option for the stress urinary incontinence. These good results must be confirmed in prospective randomized trials.

Clinical Study of Combined Endoscopic And Percutaneous Management of a Late Complication Following Tension-free Vaginal Tape (TVT) Anchored Stone for Female Stress Urinary Incontinence

TVT is a simple and less-invasive variation of the suburethral sling with higher success rates1. It has beenrapidly gaining popularity worldwide but it has also lead to increasing number of patients presenting withassociated complications. Bladder erosion through the bladder wall occuring predominantly within the first2 years the placement of TVT is producing tension or in the close proximity of the bladder..Formation of acalculus in the urinary bladder secondary to an intravesical mesh erosion is relatively infrequent rare anddelayed complication.Owing to the scarcity of the data on mesh erosion there is no consensus regarding theideal approach to remove the mesh Combined endoscopic and percutaneous approach should be opted as thepreferred approach .Open surgery should be opted only if minimal invasive approach fails.

Autologous Fascial Slings for Surgical Management of Stress Urinary Incontinence: A Come Back.

Stress urinary incontinence (SUI) is a common type of urinary incontinence adversely affecting the quality of life of women. For mild SUI, life style changes, pelvic floor exercises and medical treatment with duloxetine may help. Most patients of moderate to severe SUI usually require surgical treatment. Various surgical treatment options include Kelly's plication, Burch colposuspension, bulking agents and sling surgeries. Although, suburethral fascial slings including the autologous rectus fascia slings were in vogue before 1990, they were overtaken by minimally invasive, faster and easier artificial midurethral slings (tension free vaginal tape and transobturator tape). However, observation of serious long-term and life changing complications of synthetic midurethral slings like mesh erosion, chronic pelvic pain and dyspareunia led to their adverse publicity and medico legal implications for the operating surgeons. This led US FDA (Food and Drug Administration) to issue a warning against their use. Currently, their use has significantly decreased in many countries, and they are no longer available in some countries. This has led to renaissance of use of natural autologous fascial sling, especially rectus fascia for surgical management of SUI. Although performing rectus fascia sling surgery is technically more challenging, takes longer, has more short-term morbidity like voiding dysfunction, their long-term success is high with very little risk of serious complications like mesh erosion, chronic pelvic pain and dyspareunia. However, multicentric trials and longer follow ups are needed before it's routine recommendation This review discusses the role of autologous fascial sling (especially rectus fascia) for the surgical management of SUI in the current time and the need of ongoing training of this procedure to gynecology residents and urogynecology fellows.

The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country.

Objectives:To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI).Methods:We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6).Results:Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure.Conclusions:All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI.

Adjustment of tension applied in transobturator tapes in females with intrinsic sphincteric deficiency: Two centers' prospective, comparative, randomized surgical trial.

Objectives:Stress incontinence is the most common type of urinary incontinence in females. Recently, the gold standard treatment is mid-urethral tapes, however their efficacy is questioned in intrinsic sphincter deficiency (ISD). In our study, we try to adjust the tension applied during transobturator tapes (TOT) to evaluate its effectiveness in ISD, in order to prevent obstruction or failure and persistence of stress urinary incontinence.Materials and Methods:This study was prospectively conducted on eighty female patients having ISD, presenting at the Urology Departments in Alexandria and Minia University Hospitals. The patients were randomly assigned to two groups, with Group I including forty patients, who underwent TOT using tension-free technique, and Group II including forty patients using our new tension adjustment technique under saddle anesthesia. Patients filled the International Continence Questionnaire and Urinary Distress Inventory and did pressure flow study pre- and postoperatively. Postoperatively, the patients filled Patient Global Impression of Improvement and underwent translabial ultrasound (U/S) to estimate the distance between the tape and the urethra.Results:In Group I, 70% of the patients were cured with mean Valsalva leak point pressure (VLPP) of 51.43 ± 3.39 preoperatively, 20% were not improved, and 10% were improved with a mean VLPP of 44.5 ± 3.54 preoperatively, which increased to 86 ± 4.24 postoperatively. In Group II, 95% of the patients were cured with a mean VLPP of 50.74 cmH2O ± 6.56 preoperatively and 5% improved but not cured with a mean VLPP of 31 cmH2O preoperatively, which increased to 127 cmH2O at a bladder capacity of 400 ml. All patients in both groups underwent translabial U/S 6 months postoperatively. The distance between the mid-tape and the outer urethra measured by translabial US showed no significant difference between the two studied groups.Conclusion:Performing TOT using our tensioned proposed technique in ISD seems to be effective and with low morbidity. Intraoperative adjustment of tension using Valsalva maneuver under saddle anesthesia gives better outcomes than the conventional tension-free technique. The concept of tension-free vaginal tape should be challenged.

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.

The tension‐free vaginal tape operation: Is the inexperienced surgeon a risk factor? Learning curve and Swedish quality reference

IntroductionTo reduce the risk of avoidable damage to the patient when training surgeons, one must predefine what standards to achieve, as well as supervise and monitor trainees' performance. The aim of this study is to establish a quality reference, to devise comprehensive tension‐free vaginal tape (TVT) learning curves and to compare trainees' results to our quality reference.Material and methodsUsing the Swedish National Quality Register for Gynecologic Surgery, we devised TVT learning curves for all Swedish TVT trainees from 2009 to 2017, covering their first 50 operations. These outcomes were compared with the results of Sweden's most experienced TVT surgeons for 14 quality variables.ResultsIn all, 163 trainees performed 2804 operations and 40 experienced surgeons performed 3482 operations. For our primary outcomes – perioperative bladder perforations and urinary continence after 1 year – as well as re‐admission, re‐operation and days to all daily living activities, there was no statistically significant difference between trainees and experienced surgeons at any time. For the first 10 trainee operations only, there were small differences in favor of the experienced surgeons: patient‐reported minor complications after discharge (14% vs 18.4%, P = .002), 1‐year patient‐reported improvement (95.9% vs 91.8%, P < .000), and patient satisfaction (90.9% vs 86.2%, P = .002). For both trainee operations 1‐10 and 11‐50, compared with experienced surgeons, operation time (33.8 vs 22.2 min, P < .000; 28.3 vs 22.2 min, P < .000) and hospital stay time (0.16 vs 0.06 days, P < .001; 0.1 vs 0.06 days, P < .001) were longer, perioperative blood loss was higher (27.7 vs 24.4 mL, P = .001; 26.5 vs 24.4 mL, P = .004), and patient‐reported catheterization within 8 weeks was higher (3.9% vs 1.8%, P < .000; 2.5% vs 1.8%, P = .001). One‐year voiding difficulties for trainee patients (operations 1‐10:14.2%, P = .260; operations 11‐50:14.5%, P = .126) were comparable to the experienced surgeons (12.4%).ConclusionsThere is a learning curve for several secondary outcomes but the small effect size makes it improbable that the difference has clinical significance. Our national Swedish results show that it is possible to train new TVT surgeons without exposing patients to noteworthy extra risk and achieve results which are equivalent to the most experienced Swedish surgeons.

4-year recurrence risk factors after tension-free vaginal tape-obturator as a treatment of stress urinary incontinence

Objectives: Tension-free vaginal tapes are the gold standard of the surgical treatment of stress urinary incontinence (SUI); however, long-term recurrence of SUI after this surgery has been a matter of problem. Here, we attempted to determine the incidence of its recurrence and to identify the risk factors of 4-year-recurrence of SUI after this surgery. Methods: Of all patients undergoing this surgery (n = 341, 2015-2019), 71 patients were met the study inclusion criteria. Of 71, SUI recurred in 8 patients, with the recurrence rate being 11.3%. The following three were identified to be independent risk factors: older age, history of delivery of macrosomic baby (&gt;4 kg), and the presence of mixed urinary incontinence. The frequency of recurrence in cases with mixed incontinence amounted for 19.5%. Recurrence was 22 and 50% for women with macrosomic delivery once and more than twice, respectively. Conclusion: Advanced age, macrosomic delivery and mixed urinary incontinence have shown to be independent risk factors of recurrence of SUI after tension-free vaginal tape-obturator at 4 years. Key message: Stress urinary incontinence can recur so investigate possible risk factors is a priority. Our paper relates recurrence with: advanced age, fetal macrosomia and mixed incontinence.

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.

When Should We Remove Urinary Catheter After TVT Procedure?

As like most gynecologic operations, after tension-free vaginal tape, urinary catheter usually has been stayed to prevent postoperative urinary retention. Our aim at this study was to compare effects of early versus delayed catheter removal after tension-free vaginal tape. Patients with stress urinary incontinence observed with cough stress test or intrinsic sphincter deficiency detected on urodynamic evaluation were included. Patients with pelvic organ prolapse, positive or unavailable preoperative urine culture report, comorbid systemic illness, and TVT performed with benign or malign gynecologic surgeries were excluded from the study. Computer-generated randomization was used, and allocation group was kept in closed envelope: group I: catheter removed within first 6 h after surgery (0–6 h) and group II: catheter removed 24 h later. Seventy patients performed TVT for stress urinary incontinence were enrolled in this study and equally assigned to two groups. Of 35, 4 patients (11.4%) required recatheterization in group I while no one from late removal group. Twelve patients (34.2%) had positive culture at day 2 postoperative from group II as compared with 4 patients (11.4%) of group I (P = 0.042). Both of the two groups’ success rate after postoperative 2 weeks examination with cough-stress test was similar to 32 patients (91.4%) for group I whereas 33 patients (94.2%) for group II. Early removing of catheter after TVT did not affect operation success rate. It was also associated with a lower incidence of urinary tract infections and lower incidence of positive urine culture. Beside this, there was no adverse outcome like significant rate of recatheterization.

TVT-O vs TVT-S for female stress urinary incontinence: A systematic review and meta-analysis.

Tension-free vaginal tape obturator (TVT-O) and tension-free vaginal tape secur (TVT-S) are common surgeries for the treatment of stress urinary incontinence (SUI), several randomised controlled trials (RCTs) have compared the effects of TVT-O and TVT-S, yet the results remained inconsistent. Therefore, we attempted to conduct this systematic review and meta-analysis to analyse the role of TVT-O and TVT-S in patients with SUI. We searched PubMed databases from inception date to Jan 15, 2020 for RCTs that compared TVT-O and TVT-S in SUI patients. Two authors independently screened and extracted data from the published articles. Summary odd ratios (OR) or mean differences (MD) with 95% confidence intervals (95% CI) were calculated for each outcome by fixed- or random-effects model. Seven RCTs with a total of 755 patients were identified, with 373 patients for TVT-O and 382 patients for TVT-S. TVT-O preceded TVT-S in the objective cure at 12months (OR=1.72, 95% CI 1.21-2.45), subjective cure (OR=1.98, 95% CI 1.08-3.62); but TVT-S have more advantage in the incidence of postoperative thigh pain (OR=18.94, 95% CI 7.01-51.15); no significant differences on the duration of operative procedure (OR=-1.09, 95% CI -2.37-0.18), urinary retention (OR=0.77, 95% CI 0.36-1.62) and urinary infection (OR=1.80, 95% CI 0.63-5.13) were found. TVT-O should be preferred for patients with SUI even though with higher risks of postoperative thigh pain when compared with TVT-S, more related studies are needed to identify the role of TVT-O and TVT-S for the treatment of SUI.

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.

438 - Surgical technique of laparoscopic nephropexy using TVT (Tension free Vaginal Tape) for patients with symptomatic nephroptosis

438 - Surgical technique of laparoscopic nephropexy using TVT (Tension free Vaginal Tape) for patients with symptomatic nephroptosis

Facteurs prédictifs de rétention aiguë d’urine ou de dysurie en postopératoire immédiat après pose de bandelette sous urétrale : revue de la littérature

Immediate postoperative urinary retention (UR) and voiding dysfunction (VD) are some factors limiting outpatient procedure for mid-urethral sling (MUS) surgery in women presenting with stress urinary incontinence. The objective of the current review was to report the main predictive factors associated with immediate postoperative UR/VD following MUS surgery in women. A systematic review was performed using Medline database, according to PRISMA methodology, using following keywords midurethral sling; tension-free vaginal tape; TVT; transobturator tape; TOT; predicting factor; voiding dysfunction; urinary retention; postvoid residual; postoperative residue of urine. Thirteen studies were included. Main clinical predictive factors associated with immediate postoperative urinary retention (UR) and voiding dysfunction (VD) were: previous pelvic surgery (hysterectomy, incontinence or pelvic organ prolapse surgery) [OR: from 3.7 ((CI95%: 1.14-12.33); P=0.029)] to 8.93 [(CI95%:1.17-61.1); P=0.035)], previous UR [OR: 415 (CI95%: 20-8619); P<0.001], age over 65 y/o [OR: 3,72 (CI95%:1.40-9.9); P<0.01], and general anesthesia [OR: 4.5 (CI95%:1.1-18.9); P=0.02]. Urodynamic predictive factors were underactive bladder at cystometry [OR: from 2.52 ([CI95%: 1.03-6.13]; P=0.042) to 5.6 ([IC95%: 1.6-19.2]; P=0.02] and preoperative maximum flow rate (Qmax) (the prevalence of UR was ranging from 12 to 35% when Qmax was under 15ml/s, versus 0% when Qmax was over 30ml/s). Predictive factors associated with immediate postoperative UR/VD following MUS surgery in women were age over 65 y/o, previous pelvic surgery or previous UR, underactive bladder and preoperative Qmax under 15ml/s.

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.

The value of MRI in assessment of the functional disorders of stress urinary incontinence in women

Objective To investigate the application value of MRI in evaluating the disorders of pelvic floor in female stress urinary incontinence (SUI). Methods From January 2017 to January 2019, the patients in the SUI group and the control group of Beijing Chaoyang Hospital, Capital Medical University were prospectively collected. Some patients in the SUI group were treated with tension-free vaginal tape (TVT). The dynamic MR was performed in both SUI patients and volunteers, and the following functional MR parameters were assessed between two groups: the urethral length and urethral hypermobility; the opening of urethral and bladder neck; and the pelvic organ prolapse. For SUI patients, the functional changes of the pelvic floor on MRI after TVT was also analyzed. Chi-square test, rank-sum test and t test were used. Results Comparing with the control groups (n=25), the urethral hypermobility, shortening functional urethral length, bladder neck funneling and urethra opening were significantly associated with SUI group (n=33). Thirty one patients were treated with TVT, 12 of them were reexamined with MRI at 3 to 6 months after operation. Postoperative MR showed that SUI patients had lower risk of the urethral opening and bladder neck funneling (P 0.05). Conclusion MRI can accurately evaluate pelvic floor function of SUI patients. However, TVT did not significantly improve weak pelvic supporting structures and pelvic organ prolapse. Key words: Urinary incontinence, stress; Magnetic resonance imaging; Tension-free vaginal tape; Pelvic floor disfunction; Pelvic floor

MP41-13 SURGICAL TECHNIQUE OF LAPAROSCOPIC NEPHROPEXY USING TVT(TENSION FREE VAGINAL TAPE) FOR PATIENTS WITH SYMPTOMATIC NEPHROPTOSIS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-13 SURGICAL TECHNIQUE OF LAPAROSCOPIC NEPHROPEXY USING TVT(TENSION FREE VAGINAL TAPE) FOR PATIENTS WITH SYMPTOMATIC NEPHROPTOSIS Ghazal Ameli*, Peter Weibl, Larissa Prüger, and Wilhelm Alexander Hübner Ghazal Ameli*Ghazal Ameli* More articles by this author , Peter WeiblPeter Weibl More articles by this author , Larissa PrügerLarissa Prüger More articles by this author , and Wilhelm Alexander HübnerWilhelm Alexander Hübner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephropexy has been under debate since its introduction to surgery. In fact, persistently arising flank pain and/or functional impairment in an upright position - verified in split renal function test - constitute an indication for intervention. In keeping with the previously by Huebner et al. published technique in 2004, we report on laparoscopic nephropexy using tension-free vaginal tape (TVT) for symptomatic nephroptosis. The aim of the study was to describe our surgical technique and report about a longer follow-up, as these surgeries were not embedded in a prospective study to begin with, there was also no academical protocol for the postoperative course. METHODS: From 3/2000 to 5/2019, 21 women (mean age 37.1 yr.) with symptomatic and radiographically proven (ultrasound and intravenous pyelogram) nephroptosis, were treated by laparoscopic nephropexy using a TVT tape.After standardized laparoscopic mobilization of the lower pole of the kidney, idendification of the ureter and renal pelvis, the needle of the TVT is directed below the lower pole of the kidney and pushed through the abdominal wall paravertebrally, just under the level of 12th rib. Afterward it is pushed through the abdominal wall again and guided over the lateral margins of the kidney. The sling is tightened until the kidney is fixed to the dorsal wall of the abdomen in a “loose fit” manner. No further fixation is needed. No postoperative drainage was placed. RESULTS: In all 21 cases the procedure was easily performed without any intraoperative complications. The mean operating time was 47.8 min. and the hospital stay after surgery was in average 4 days. Three patients required postoperative pain management according to Clavien-Dindo I, but there were no other complications. Postoperative intravenous pyelogram and ultrasound showed no recurrence in all cases after a mean follow up of 115.7 mts (range 2,8-227). 19 (90,5%) patients reported an improvement of symptoms, 2 (9,5%) complained about transient pain episodes 13 and 20 days, respectively. The visual analog score improved from 6.2 to 1.1. CONCLUSIONS: Using a tension-free vaginal tape for laparoscopic nephropexy is a safe and technically feasible procedure. In fact, prospective studies as well as good clinical results in a bigger cohort may be appreciated. However, leaving out the discussions about indications for nephropexy, we believe this simple technique is worth being presented to other urologists in order to broad the horizons of laparoscopic nephropexy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e599-e600 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ghazal Ameli* More articles by this author Peter Weibl More articles by this author Larissa Prüger More articles by this author Wilhelm Alexander Hübner More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluation of a 3D Printed Female Anatomical Model for the Hands on Training of Trans-Obturator Tape (TOT) and Tension Free Vaginal Tape (TVT) Sling Procedures

Evaluation of a 3D Printed Female Anatomical Model for the Hands on Training of Trans-Obturator Tape (TOT) and Tension Free Vaginal Tape (TVT) Sling Procedures