TVT-secur: a minimally invasive procedure for the treatment of primary stress urinary incontinence. One year data from a multi-centre prospective trial

Abstract

The objective of this study is to evaluate the efficacy and morbidity of the new minimally invasive TVT-secur procedure. This was a prospective multi-centre trial. All patients with primary urodynamic stress urinary incontinence were prospectively selected to receive the TVT-secur procedure. The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS), Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on quality of life (QoL) and to measure patient's perception of incontinence severity and improvement. The SPSS software was used for data analysis. From November 2006 to September 2007, 95 consecutive patients were enrolled in the study. At 1 year, 91 patients were available for the analysis. The subjective and objective cure rates were 78% and 81%, respectively. The ICIQ-SF and W-IPSS symptoms score showed a statistically significant decrease. Post-operative complications included voiding difficulty, recurrent UTI, de novo urgency incontinence and dyspareunia. Our data show that TVT-secur is associated with an 80% success rate at 1 year.

“U-Method” TVT-Secur Slings: Are they obstructive?

“…This may be because we only performed the "U-method," although conflicting data exist regarding the better outcome of one technique over the other. [5][6][7]16 No major complications were reported during the procedures. However, there was a higher occurrence of transient urinary retention (12%) than in previous studies, 6,10,11 which reported rates of less than 1%, but comparable to the other conventional slings.…”

“…The success rate of the TVT-Secur is generally between 58% and 85%, [6][7][8][9][10][11]15,16,25 although a success rate as high as 94.6% has been reported. 9 Its success rate is generally lower than the more conventional slings, with success rates around 90% to 92% for the TVT and between 87% and 90% for the TOT.…”

“…A better clinical outcome using the "U-Method" has been reported, 5 although other studies found no difference between both techniques. 6,7 No matter which technique is used, it is recommended to maximally tighten the sling to create a "pillowing effect" on the urethra (filling of the tape pores with suburethral tissue) until obtaining a negative stress test because the tape does not retract as much as its longer counterpart 8 and is pushed on the tissues rather than pulled.The short-term results on the safety and efficacy of the procedure seems promising. 9-11 However, no study has assessed the effect of the "U-method" on voiding patterns 12 months after its implantation.…”

“…23 Hsiao and colleagues compared the preoperative and postoperative UDS in patients who underwent the TVT or TOT (Monarc) procedures. 24 No significant differences were observed between both procedures with regard to their impact on bladder voiding and storage functions, although the TOT did lower the Q max (-2.4 mL/s) on the 12-month follow-up UFM.The success rate of the TVT-Secur is generally between 58% and 85%, [6][7][8][9][10][11]15,16,25 although a success rate as high as 94.6% has been reported. 9 Its success rate is generally lower than the more conventional slings, with success rates around 90% to 92% for the TVT and between 87% and 90% for the TOT.…”

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women

“…This cure rate fell down to 85% at the end of a year, due to vaginal tape exposure, requiring sectioning of the tape in 2 patients. Other centres implanting TVT-Secur have published cure rates of 77.2% at 4 months as by Mossa et al, 6 to 78-81% by Meschia et al 7 and Walsh, 8 and to 87.1% by Kim et al 9 Even lower cure rates of 68.2% at one year have been reported by Joo et al 10 Han et al 11 on the other hand have cited that the overall success rate after TVT-Secur implantation was maintained over a period of 3 years although the cure rate fell down to 72.9%. Cure rates with other mini-slings like Mini-Arc have ranged between 80 and 92% at the end of one year, as per the studies by Annett et al 12 and by Daneshgari et al 13 The improvement in the patient satisfaction and Incontinence specific QOL scores, as measured by Mann-Whitney U test of both UDI-6 and IIQ-7, was statistically significant at 95% and 99% confidence levels.…”