Tension-free vaginal tape: avoiding failure

Abstract

A prospective, single-centre study to assess the outcome of incontinence surgery in the first 120 consecutive patients who had tension-free vaginal tape (TVT) by a single surgeon. All patients were initially seen at 3 months postsurgery, with a cough provocation test, measurement of residual urine volume and a satisfaction survey. At a mean of 26 months (6-42 months) after surgery, a validated telephone interview was performed. The operation was performed in accordance with the original technique described by Ulmsten et al. [Int Urogynecol J Pelvic Floor Dysfunct 1996; 7: 81-5]. A total of 87 of 120 patients completed the study with the others either not complying or having died. Sixty-three (72.4%) patients were completely dry on cough provocation test. Of these, four (4.5%) had a slow stream and 10 (11.4%) suffered persistent urgency. The remaining 24 patients had varying degrees of leakage (operative failure). Sixteen (18.3%) patients subjectively considered the procedure to have failed at 3 months follow-up, either because leakage occurred once or more a day, and/or the persistence of the preoperative frequency/urgency syndrome. Of these 16 TVT failures, two had previous pelvic radiotherapy, two had double incontinence and eight had TVT for recurrent incontinence. Among the failures, 81.3% had mixed incontinence with predominant urge and nocturia three times per twenty four hours. Our study highlights the need for selection when performing TVT. We recommend that TVT be performed for those who have simple stress incontinence failing conservative measures (pelvic floor exercises and physiotherapy), with no history of incontinence surgery, pelvic radiotherapy, faecal or mixed incontinence.

Trans-Obturator Tape for Incontinence: A 3-Year Follow-Up

“…There were also no cases of perineal pain which other studies have described [7] and attributed to possible close proximity of the tape to the obturator nerve. Urethral injury did not occur due to direct protection of the structure with the operator's finger during dissection.…”

“…The functional results between TVT and TOT are the same in our practice and largely depend on patient selection [7] . DeTayrac et al [8] reported a 90% objective cure in the TOT group as compared with 84% in the TVT group, with relatively equal morbidity at 1 year (range 7-17 months) of follow-up.…”

Traitement chirurgical de l’incontinence urinaire féminine par bandelette sous-urétrale : laquelle ? Comment ?

“…En revanche, Singary [84], Koops [71] et Holmgren [85], dans des é tudes comparant les ré sultats du TVT 1 implanté pour traiter une incontinence urinaire d'effort pure ou une incontinence urinaire mixte, retrouvent une baisse significative des taux de succè s dans cette deuxiè me indication (72,4 versus 48 %, 81,3 versus 65,7 %, 85 versus 60 %).…”

Existe-t-il des facteurs pronostiques conditionnant le succès de la chirurgie de l'incontinence urinaire d'effort parbandelette sous-urétrale libre?

“…Incontinence urinaire mixte (Tableau 5) Al-Singary et al [29], Koops et al [30] étudient l'influence pronostique de l'incontinence urinaire mixte préopératoire.…”