TVT Procedure Research Articles

Comparison of intraoperative and postoperative complications in the treatment of stress urinary incontinence after TVT and TOT procedures a literature review

Comparison of intraoperative and postoperative complications in the treatment of stress urinary incontinence after TVT and TOT procedures a literature review

Long-term results of a prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in stress urinary incontinence.

This study was aimed at investigating the long-term effectiveness of minimally invasive mid-urethral sling (MUS) surgery and at comparing the outcomes between retropubic (tension-free vaginal tape, TVT) and transobturator tape (TOT) methods in the treatment of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with a predominant stress component in a long-term follow-up of a randomized controlled trial. This work is a long-term follow-up study of a previous prospective randomized trial conducted in the Department of Obstetrics and Gynecology at Oulu University Hospital between January 2004 and November 2006. The original 100 patients were randomized into the TVT (n=50) or TOT (n=50) group. The median follow-up time was 16 years, and the subjective outcomes were evaluated using internationally standardized and validated questionnaires. Long-term follow-up data were obtained from 34 TVT patients and 38 TOT patients. At 16 years after MUS surgery, the UISS significantly decreased from a preoperative score in the TVT (11.88 vs 5.00, p<0.001) and TOT (11.05 vs 4.95, p<0.001) groups, showing a good long-term success of the MUS surgery in both groups. In comparing the TVT and TOT procedures, the subjective cure rates did not differ significantly between the study groups in long-term follow-up according to validated questionnaires. Midurethral sling surgery had good long-term outcomes in the treatment of SUI and MUI with a predominant stress component. The subjective outcomes of the TVT and TOT procedures were similar after a 16-year follow-up.

A0570 - A comparative study for long-term surgical outcomes between TVT and TOT procedures in obese and non-obese women with stress urinary incontinence

A0570 - A comparative study for long-term surgical outcomes between TVT and TOT procedures in obese and non-obese women with stress urinary incontinence

Long-term efficacy and complications of a multicentre randomised controlled trial comparing retropubic and transobturator mid-urethral slings: a prospective observational study.

There are concerns regarding the risks of mid-urethral slings (MUS) for stress urinary incontinence (SUI), particularly because of the lack of long-term data. We compare patient-reported outcomes of a multicentre randomised controlled trial of retropubic (TVT, GYNECARE™) versus transobturator (TOT, MONARC™) tape surgery at 12 years. A multicentre study was performed in 11 tertiary referral centres. A cohort of 180 participants from the original trial, the majority of whom had mixed urinary incontinence. Postal questionnaire survey of patient-reported outcome measures using the International Consultation on Incontinence Questionnaire, Patient Global Impression of Improvement questionnaire (PGI-I) and a numeric rating scale pain questionnaire. Comparison of the efficacy and complications between the TVT and TOT procedures in the long term. A total of 110/180 responses were received: 55 for TVT and 55 for TOT. The mean follow-up was 12.8 ± 0.29 years (SD). TVT was significantly superior to TOT: 41.8% TVT with no SUI, versus 21.8% TOT (P = 0.04). Urgency urinary incontinence (UUI) was the most bothersome urinary symptom: 14.5% of respondents reported UUI after TVT and TOT. This was an improvement from the baseline levels: 61.8% TVT and 76.4% TOT. Seventeen patients (9 TVT and 8 TOT) out of 121 reported moderate or severe pain with severe pain in 3 with TVT and 2 with TOT. Overall, 80% TVT and 77% TOT participants reported their symptoms as improved on the PGI-I. TVT is superior to TOT for SUI cure. Efficacy is reduced by 12 years. There is low incidence of severe vaginal or groin pain. Careful patient counselling on long-term outcomes is required. The Retropubic tape appears to be an effective treatment for the majority of women with SUI. Retropubic tape has superior efficacy to transobturator tape. Complications are comparable with low rates.

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.

364 - Long-term outcomes from TVT procedures for treatment of female stress urinary incontinence: Data from a minimum of 18 years of follow-up

364 - Long-term outcomes from TVT procedures for treatment of female stress urinary incontinence: Data from a minimum of 18 years of follow-up

A retrospective comparison of various stress urinary incontinence surgery with there outcome in a tertiary care teaching institute

Stress urinary incontinence is defined as the involuntary loss of urine through the intact urethra caused by a sudden increase in intraabdominal pressure on coughing, walking and in some cases during turning in bed. It is the most common type of urinary incontinence in woman and when it is of sufficient quantity causes a great embarrassment which was frequently underreported UI impairs quality of life, affecting the older person's emotional well-being, social function, and general health. Incontinent persons often manage to maintain their activities, but with an increased burden of coping, embarrassment, and poor self-perception. Caregiver burden is higher with incontinent older persons. This was a hospital based retrospective study in the department of Gynecolog at kem hospital mumbai India. Total duration of study from enrollment to completion was 2 years. Each patient was followed for 6 month In the present study the patient presenting to gynecology OPD of k. e. m. hospital with complaint of urinary incontinence were studied. A total 50. patient were included in following study. Working definition was used for classification. History was documented including Age, occupation, severity, duration and frequency of SUI, other menstrual history, urinary symptoms, detail obstetric history, parity, gynecological procedure, pelvic floor trauma, previous urinary tract infection, previous surgeries. trauma in childhood, any spinal surgery, or drugs. A focused physical examination was performed. Lastly stress incontinence was clinically confirmed by “ Bonneys test “. Anal sphincter tone ad sensation at S dermatomes are checked to rule out any neurological lesion. The data were analyzed using appropriate statistical tool. A total no patient enrolled was 50 during the study period. Majority of the patients fall in the range of 30-50 year of age. Most of the patient having duration of symptoms less than 2 year with more common SUI in multiparty patient, about 60% of patient were having SUI without any previous surgery, 62% of SUI was associated with prolapsed with cystorectocele. In I ntraoperative complication only one patient having bladder perforation in TVT procedure. In post operative complication urinary retention was found 30% in kellys placation, 20% in stameys, 20% in TVT, 00% in TOT. However only kellys plication has more recurrence of SUI in about 33%, 12.5% of recurrence in TVT and 8.3% in TOT of patient. As in stameys the number of follow up patient was only two and none of them had recurrence of sui. This study is concluded that, since the symptoms of SUI are not life threatening and most of the female are less health conscious the medical help is not sought for longer duration. In the study TOT procedure was found superior with respect long term failure rate and also intra and post operative complication

Transvaginal Cystocele Repair Using Tension-free Polypropylene Mesh (Tension-free Vaginal Tape)

Urinary incontinence is one of the most common diseases, 25% of women between 18 and 80 years suffer from it. Urinary incontinence can be described as accidently loss of small amounts of urine. The solution involves a surgical procedure, such as sling procedures and bladder neck suspension procedures. The methods of surgical interventions have evolved due to a minimum period of hospitalization (sling, TVT), or performing laparoscopic surgery instead of the classical Burch surgery. Studies reviled that the most effective interventions are those which restore the urethra by retro pubic urethropexy, pubovaginal sling and synthetic mid-urethral slings. This type of surgery has currently the highest success rate (85-90% on 5 years after surgery), and the lowest relapse rate. In our study we obtained the same success rate for the TVT procedure.

24: Post-operative patient-initiated telephone calls in an academic female pelvic medicine and reconstructive surgery practice: A retrospective study

The purpose of this study was to evaluate reasons for patient calls in the post-operative period. Secondarily we evaluated: (i) factors associated with the number of phone calls in the post-operative period (ii) demographic differences between callers versus non-callers. After IRB approval, a retrospective chart review using electronic medical records was performed on consecutive patients who underwent surgery within our academic FPMRS practice from January 1, 2017 to June 30, 2017, inclusive. Calls following post-operative discharge until their first scheduled post-operative visit were included. Reasons and number of calls were tabulated. Demographic information including clinical and surgical factors was extracted. Continuous data (e.g., number of phone calls) were evaluated with a Student’s t test or ANOVA; categorical data were evaluated with a chi square test. Results yielding p < 0.05 were deemed statistically significant. Three hundred two patients underwent surgery during the designated period of time. One hundred seventy-three (57.3%) patients made a total of 345 calls with mean of 2.0 ± 1.5 calls each. There was no difference in age or BMI between callers and non-callers. A greater number of telephone calls in the post-operative period was recorded among patients discharged home with catheters (p = 0.015) and patients who underwent posterior colporrhaphy (p = 0.005), TVT (p = 0.004), and retropubic urethropexy (p = 0.014) procedures. Reasons for phone calls were categorized under six distinct domains: bowel, pain, activity, medication regimen, urinary, and bleeding. The most frequent concern under each domain included constipation (11.6%), abdominal pain (6.4%), physical activity (8.7%), pain regimen (14.5%), urinary catheter related (13.3%), and vaginal bleeding (12.1%), respectively. The highest volume of phone calls was received for urinary catheter-related issues (10.4%), pain regimen (8.4%), urinary tract infection symptoms (6.7%), constipation (6.7%), vaginal bleeding (6.4%), and voiding issues (5.2%). The volume of phone calls was not impacted by surgical history, medical history, or hospital admission status. Patients discharged with home nursing (11, 6.4%) demonstrated a significantly higher number of phone calls (mean ± SD = 3.82 ± 2.52) than patients discharged home without nursing (153, 88%; 1.89 ± 1.32, respectively; p < 0.001). Thirty-seven percent of callers necessitated an evaluation with a provider or nurse based on their reported concerns. Post-operative patient-initiated telephone calls after FPMRS surgery are common in our practice, occurring in more than half of all patients undergoing a procedure, and specifically more frequent in women discharged home with nursing. Bowel, urinary, and medication-based phone calls account for the highest frequency and volume.

Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis.

One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies. This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (≥5years) efficacy and safety of MUS in women affected by SUI were included. A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both out-in and in-out) were 61.6% (95% CI: 58.5-64.8%) and 76.5% (95% CI: 73.8-79.2%), and 64.4% (95% CI: 61.4-67.4%) and 81.3% (95% CI: 78.9-83.7%) respectively. When considering TOT using the out-in technique (TOT-OI) and TOT using the in-out technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7-60.7%) and 81.6% (95% CI: 78.8-84.4%), and 68.8% (95% CI: 64.9-72.7%) and 81.3% (95% CI: 77.9-84.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 [95% CI: 0.49-1.53], I 2 = 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46-1.55], I 2 = 68%, p = 0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 [95% CI: 0.97-9.51], I 2 = 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40-8.48], I 2 = 88%, p = 0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 [95% CI: 0.54-1.28], I 2 = 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17-3.46], I 2 = 86%, p = 0.73). Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up.

Risk factors for postoperative urinary tract infection following midurethral sling procedures

ObjectiveTo identify the potential risk factors for urinary tract infections following midurethral sling procedures. Study design556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4–8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn’t were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. ResultsOf 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (p<0.001). The presence of menopausal status, previous abdominal surgery, preoperative antibiotic treatment due to urinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1–0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1–22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1–19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings ConclusionUrinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies.

A prospective randomized study of TOT and TVT procedure for female intrinsic sphincter deficiency (ISD)

Objective To compare the outcomes of TOT and TVT procedure treating female intrinsic sphincter deficiency (ISD). Methods From May 2010 to September 2015, 42 stress urinary incontinence(SUI) patients whose abdominal leak point pressure was less than 60 cmH2O were enrolled in this study. Thirty-five patients were followed up. The mean age was (56.8±10.5) years, with a range of 30-80 years. The mean history was(10.5±9.1)years, with a range of 4 months to 30 years, with 26(74.3%) of them being postmenopausal, 5(14.3%) having a history of pelvic surgery, and no pelvic organ prolapsed or hormone replacement. All of them were randomly divided into 2 groups to undergo either TVT operation (13 cases) or TOT operation (22 cases). The baseline characteristics of the two groups including age, length of history, urodynamic parameters and scale scores showed no significant difference. The scales including urinary incontinence severity score (UISS), detrusor instability score (DIS), Quality of Life Scale Evaluation (I-QOL), lower urinary tract symptoms affect score (UDI-6) were used. The outcomes between TVT group and TOT group were compared. Result After procedure, patients in TVT group got a lower UISS score than TOT group(17.2±2.2 vs.17.7±3.1), and their severity of urinary incontinence improved significantly (P<0.05). Patients from TVT group got a lower DIS score than TOT group(12.6±4.2 vs.14.2±3.5), and their detrusor instability symptoms improved more significantly (P<0.05). Patients from TVT group got a higher I-QOL score than TOT group(17.5±14.5 vs.16.1±13.0), and their quality of life improved more significantly (P<0.05). Patients from TVT group got a lower UDI-6 score than TOT group(10.1±3.0 vs.11.2±3.4), and their lower urinary tract symptoms improved more significantly (P<0.05). Conclusion Urinary incontinence of female ISD patients were improved greater by TVT than TOT procedure. Key words: Tension-free sling operation; Intrinsic sphincter deficiency (ISD); Outcome; Surgical approach chosen

The use of synthetic materials in the treatment of stress urinary incontinence.

Stress urinary incontinence is a very serious problem which has been noticed by the WHO. This difficult medical condition poses a serious problem as it affects c.a. 20% of the female population and it increases up to 35% in the group of females over 60 years of age. Since there is no single standard surgical procedure which could solve this problem, numerous synthetic materials are used for the operations. It seems that the materials are effective as they improve the condition of women suffering from stress urinary incontinence. Unfortunately these materials have their shortcomings which might lead to certain post-operative complications. Stress urinary incontinence is a disease which affects the social life of the patients. It has a high percentage of recurrence and causes the patient substantial difficulties with keeping high standards of personal hygiene which is consequence makes it impossible to fulfill their social roles. The etiology of this disease is complex and calls for a cross-disciplinary approach to the problem. As there are no standardized or unanimous treatment methods of stress urinary incontinence, numerous sources based on the clinical experience of many medical centers suggest performing TVT and TOT procedures as the most effective treatment methods. The efficacy of the TOT procedure is about 90.8%.

Other options in the treatment of fecal incontinence

Fecal incontinence (FI) is a debilitating condition. Luckily, there are several new treatment options recently introduced or being introduced in the near future. Conservative or “non-operative” management of FI is the first step in management of a patient suffering from FI. Retrograde colonic irrigation is one alternative and is especially valuable in patients suffering from concomitant constipation. Anal plugs are disposable devices that control continence by blocking the passage of stool and may be helpful in selected groups of patients. Sacral nerve stimulation is widely used in the treatment of patients with FI and surgical repair of internal and external procidentia in patients with fecal incontinence has recently gained more interest. At the same time, dynamic graciloplasty and artificial bowel sphincter are rarely used any longer in the management of these patients. There are several treatments that are yet not FDA approved for treatment of patients with FI. The Magnetic anal reinforcement system is a novel device designed to augment the native anal sphincter. This treatment option has demonstrated good results in limited sized series of patients. The post-anal sling procedure, Topas™, has a concept similar to the TVT procedure for urinary stress incontinence. The sling is implanted dorsal to the anal canal with the aim to augment the puborectalis muscle and to restore a normal anorectal angle and a better anal sphincter function. An FDA regulated trial is presently conducted in the US. Regenerative medicine, stem cell therapy, may be the ultimate option to treat FI by regenerating impaired anal muscle. There are currently no validated techniques using this approach but there is an active research ongoing.

Incontinence-specific quality of life measures used in trials of sling procedures for female stress urinary incontinence: a meta-analysis.

We conducted this review to summarize the short-term and long-term efficacy of several midurethral sling procedures on quality of life (QoL) improvement based on incontinence-specific QoL measures in clinical trials among women with stress urinary incontinence (SUI). We searched MEDLINE (January 1966 to March 2015), EMBASE (January 1988 to March 2015), and the Cochrane Incontinence Group Specialised Register (March 2015). Only randomized controlled trials (RCTs) were eligible in this analysis. We identified 13 different condition-specific instruments in the included 31 RCTs; the Urogenital Distress Inventory (UDI), the Incontinence Impact Questionnaire (IIQ), and Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-12 (PISQ-12) were the most frequently used methods to measure QoL among women with SUI. We found that the improvement in sexual function (as assessed by PISQ-12) score was significantly higher in the single-incision slings group than in the TO-TVT group (WMD 1.06; 95 % CI 0.58-1.54); the post-operative pain visual analogue scale scores in the single-incision slings group was significantly lower than that in the TO-TVT group (WMD -1.59; 95 % CI -2.28 to -0.89). TO-TVT-treated patients had significantly greater reductions in total UDI scores (WMD 2.28; 95 % CI 1.77-2.80) and total IIQ scores (WMD 0.89; 95 % CI 0.26-1.52) than TVT-treated patients. The reduction in the total UDI score was significantly higher in the RP-TVT group than in the TO-TVT group (WMD -1.00; 95 % CI -1.65 to -0.35). Subgroup analysis of the total UDI score showed a significantly greater improvement in TO-TVT-treated patients than in TVT after long-term follow-up (>30 months), but no differences were detected after short-term follow-up (12-15 or 6 months). Our meta-analysis indicated that consistent use of the UDI and IIQ with or without the PISQ-12 might promote options for comparisons between trials. Single-incision slings were associated with significantly higher improvement in sexual function and lower post-operative pain compared with standard midurethral slings, and the long-term efficacy of TO-TVT was superior to the TVT procedure in terms of reducing the distress caused by incontinence symptoms.

Incidence and treatment of postoperative voiding dysfunction after the tension-free vaginal tape procedure.

One of the most commonly experienced postoperative complications of the tension-free vaginal tape procedure (TVT) is voiding dysfunction (VD). The aim of this retrospective study was to evaluate our incidence of postoperative VD, our results after tape mobilisation, and whether demographic data could predict VD. A total of 715 women underwent a TVT procedure without concomitant operative procedures. In the case of persisting VD transvaginal tape mobilisation was performed up to 3 weeks postoperatively. The vaginal incision was reopened and downward extraction with a clamp was performed. Demographic data were investigated to predict postoperative VD. A total of 28 patients (3.9%) experienced VD. Seventeen patients (2.4%) underwent transvaginal tape mobilisation an average of 11.6 days (range 2-21) after the primary TVT procedure. No complications were observed in connection with the mobilisation. Eleven patients (1.5%) performed clean intermittent catheterisation (CIC) for a period of more than 1 day, with an average of 14.4 days (range 3-63). After tape mobilisation 16 women (94%) were relieved of their voiding dysfunction and were continent. One woman was somewhat incontinent after the procedure. Age, parity and previous caesarean section did not predict VD. Previous incontinence surgery might predict VD. The incidence of VD after the TVT procedure requiring tape mobilisation was 2.4%. Relief of the VD was obtained after tape mobilisation in all patients. Tape mobilisation is a safe and effective treatment for postoperative VD.

TOT versus TVT – mesh surgical treatment in stress urinary incontinence

Introduction: Stress urinary incontinence is a highly debilitating condition, with an important impact over the quality of life. When the conservative treatment fails, the surgical treatment is a viable solution. Minimally invasive sling procedures have become the gold standard of surgical management for stress urinary incontinence (SUI) in women. Material and methods: The study was conducted on 68 patients with stress urinary incontinence, 52 have undergone the retropubic tension-free vaginal tape and 16 patients were operated using the transobturator tape procedure. All the patients were evaluated before the operation and the indication of the surgical treatment was established on the basis of physical examination (all the patients had positive cough test), abdominal ultrasound (to determine postvoid residual urine volume), urinalysis and urine culture (the majority of the patients have had before the operation recurrent urinary tract infections). Results: The satisfaction was similar in both groups of patients, with an average satisfaction rate of 91% for TVT and 86% for the patients who have undergone TOT procedure. The patients were in a proportion of 78,9% at menopause, with an average number of natural births of 1.9 and a mean BMI of 28.2. Regarding the surgical duration, this has varied between 20 and 40 minutes, being higher in the TVT cases (up to 5-7 minutes longer than TOT), because cystoscopy was performed during the operation to verify if the bladder was perforated or not. The urethral catheter was removed immediately after the operation in the case of the TOT procedure and in the day after the operation for the patients who have undergone TVT procedures (all of these patients associated genital prolapse). The hospitalization time was 3 days. We haven’t encountered significant intraoperative and postoperative complications. Conclusions: The TOT and TVT procedures have proven to be highly effective and safe methods in the treatment of SUI. There are no significant differences regarding the efficacy of these two surgical methods, but the risk of intraoperative complications is a little higher for the TVT procedure. The mid urethral sling procedures improve significantly the quality of life for patients with stress urinary incontinence.

Highlights of 38th annual IUGA meeting with the Continence Foundation of Ireland, Dublin, Ireland, 2013

This year the 38th annual meeting of the InternationalUrogynecological Association (IUGA) took place in Dublin,Ireland, from 28 May to 1 June at the National ConventionCenter. The sun shone gloriously for the entire event,highlightingwhat a magnificent city Dublin is. DeclanKeaneandhiscochair,BarryO’Reilly,extendedaheartywelcometothe 1,549 delegates from more than 64 countries.This year saw two notable firsts for IUGA: the physiother-apy seminar, and the inaugural IUGA golf classic, played atRoyal Dublin Golf Club in Clontarf on the site of a famousbattle between the Irish and Viking invaders in the year 1014.Themeetingwasofficiallyopenedatthewelcomereceptionon Wednesday 28 May; however, for the many participants inthe physiotherapy seminar and workshops, the meeting wasalready in full swing. The workshops continue to be of a veryhigh standard and cover a large range of specialty interests.Undoubtedly, participation allows an “up-close and personal”learning experience, with the facility for delegates to interactinformally with international experts. The scientific programran from Thursday to Saturday and consisted of 199 presenta-tions, comprising oral, podium, poster, and video sessions.The winner of the best abstract was Carl Gustaf Nilsson ofFinland: “Long-termfollow-upoftheTVToperation:17yearsresults,” which concluded that the TVT procedure proves tobe safe and effective for at least 17 years [1].Alana Murphy was the winner of the best video presenta-tion; she presented two videos from Cleveland titled “Thighexploration for excision of a transobturator tape,” and“Transvaginal repair of a neobladder–vaginal fistula” [2, 3].The initial video highlighted the complex nature of dealingwith the specific mesh complication of thigh pain; the latterwas an instructional video highlighting the surgical techniquein repairing this type of fistula.Thenexttwoawardswereforfellowswiththebestpodi-um presentation and best oral poster. The prize for the bestpodium presentation went to Jaroslava Karbanova for thebodyofworktitled“Mediolateralvs.lateralepisiotomyandassociated intrapartal complications in primiparous wom-en.”Thisrandomizedcontroltrialof790primiparouswom-en found no difference between groups with respect to therate of obstetric anal sphincter injuries (OASIS) [4]. ThewinnerofthebestoralposterpresentationwasDanielaUlrich,who presented work she had undertaken in Melbourne, Aus-tralia,titled“Biomechanicalpropertiesofgelatin-coatedpoly-amide mesh seeded with human endometrial mesenchymalstem cells.” This study concluded that such meshes were lessstiff at 90 days of implantation, a property that may be desir-able in vaginal mesh [5].The State of the Art lecture—Titanic 101, the assistantsurgeon’sstory,” wasa moving, historicalaccount ofDr. JackSimpson,theassistantsurgeononboardtheill-fatedTitanic.Itwas presented by his great nephew, Mr. John Martin, FRCS,and was a combination of historical facts and personal detail,which transported usto the mid-Atlantic on the night of April14,1912.Ameasureoftheimpactofthelecturecouldbeseenin the rapt absorption on the faces in the auditorium.This year, Pamela Moali gave the Ulf Ulmsten Lecturetitled“Exposingthe science of prolapse meshes: a foundationfor future products.” It was a scientific extravaganza lookingat all biomechanic aspects of mesh and its evolution, with the

Reasons for dissatisfaction ten years after TVT procedure

The aim of the study was to assess the reasons for dissatisfaction 10 years after TVT placement. Patients who underwent TVT surgery between 1999 and 2001 at two participating units were included. All patients who did not consider themselves to be cured were asked for their reasons. 141 out of 210 patients (81 %) were available for follow-up (median 116 months). In the group of 56 patients who did not consider themselves cured, the reasons were OAB symptoms in 29 patients (52 %), stress urinary incontinence in 13 patients (23 %), and complaints of mixed urinary incontinence in 8 patients (14 %). 85 % of all patients reporting urgency complaints at the time of follow-up and 66 % of patients with SUI at the time of follow-up did not consider themselves cured. In most cases overactive bladder symptoms were the reason for dissatisfaction. The results of this study support using composite outcomes to assess the results of surgery for urinary incontinence.

Short-Term Effect of TVT-SECUR Procedure on Quality of Life and Sexual Function in Women With Stress Urinary Incontinence

Study ObjectiveTo investigate whether patient quality of life and sexual function are improved after the tension-free vaginal tape SECUR (TVT-S) procedure (H-type). DesignProspective study (Canadian Task Force classification II-3). SettingSingle-center hospital. PatientsThirty-three women with stress urinary incontinence (SUI) (high urethral mobility) and no concomitant pelvic floor prolapse underwent TVT-S between October 2009 and October 2011. InterventionTVT-S procedure. Measurements and Main ResultsBefore and after surgery(6 and 12 months), all patients completed the Chinese version of the Incontinence Quality of Life Questionnaire (I-QOL). In addition, 28 sexually active patients who underwent the TVT-S procedure completed the short-form Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) before and after surgery (6 and 12 months). We used a paired t test to compare I-QOL scores before and after surgery. The Wilcoxon signed-rank test was used to compare the preoperative and postoperative PISQ scores. The objective cure rate was 78% (26 of 33 patients) at 12 months after surgery. The objective improvement rate was 12.1% (4 of 33 patients). The subjective satisfaction rate was 90%. Three operations (9.1%) were considered failures. Two patients underwent a TVT procedure after TVT-S because of recurrence. No patients reported severe pain; the mean (SD) visual analog scale pain score was 1.8 (1.2) after surgery. Only 1 patient (3%) was found to have sling erosion at 12 months postoperatively. The I-QOL score was 28.3 (14.2) before surgery and increased to 69.5 (18.9) at 12 months after the TVT-S procedure. The I-QOL score improved significantly after surgery (p <.001). The total PISQ-12 score at 6 months after surgery in all sexually active patients was 33.82 (0.87), compared with 31.57 (1.20) before surgery (p <.05). Physical domain scores on the PISQ-12 demonstrated significant improvement, increasing from 12.61 (0.75) to 14.36 (0.49) (p <.05). No significant difference was found between I-QOL and PISQ-12 scores at 6 and 12 months after surgery. There was no significant difference in total PISQ-12 scores in premenopausal patients before and after surgery (p >.05). ConclusionsAlthough the objective cure rate was not high, the TVT-S procedure is a minimally invasive, safe, and effective surgical procedure for treatment of SUI (high urethral mobility) and can improve the quality of life and sexual function in women with SUI.