An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence

Ulmsten, Ulf; Henriksson, Lars; Johnson, Per; Varhos, G

doi:10.1007/bf01902378

Cited by 1,559 publications

(1,180 citation statements)

References 9 publications

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“…The insertion of the TVT was performed as a variation of the technique previously reported by Ulmsten. 9 The bladder was completely emptied before the procedure by urethral catheterisation. The anterior vaginal wall was incised longitudinally over the urethra; two further 1 cm incisions were made on the abdominal wall 1 cm above the pubic tubercles on each side.…”

Section: Methodsmentioning

confidence: 99%

“…8 Ulmsten has added a new dimension in the treatment of female stress incontinence with the introduction of a synthetic polypropylene tension-free vaginal tape (TVT). 9 The placement of the TVT at the mid-urethral level is based on anatomical and pathophysiological studies 10 and supported by the ®ndings of Zaccharin 11 for the role of pubourethral ligaments in maintaining continence.…”

Section: Introductionmentioning

confidence: 99%

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Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders

Hamid

Khastgir

Arya³

et al. 2003

Spinal Cord

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Study design: Retrospective. Objective: To evaluate the safety and e cacy of the tension-free vaginal tape (TVT) for the treatment of stress incontinence in females with neuropathic bladders. Setting: London Spinal Injuries Unit, Stanmore & Institute of Urology, London, UK. Methods: Twelve women (mean age 53.3 years; range 41 ± 80 years) with neuropathic bladder dysfunction and stress urinary incontinence were treated with tension-free vaginal tape (TVT) between November 1997 and December 2000. The group consisted of women with: (i) traumatic spinal cord injuries (n=3); (ii) post lumbar spinal surgery (n=6); (iii) spinal stenosis (n=3). Four of the 12 patients had previously failed surgery for stress incontinence. All patients underwent pre-and post-TVT evaluation with video-urodynamic studies. Results: Mean follow-up was 27.1 months (range 17 ± 54 months). Three patients were voiding spontaneously (stress voiding) before surgery and continued to do so post-operatively. The remaining 9 were performing clean intermittent self-catheterisation before the insertion of TVT and continued to do so after the surgery. At follow up 10 patients (83.3%) were dry. The procedure failed in one patient and the other complained of mild leakage, but she reported a decrease in the number of pads used. One patient developed detrusor hyperre¯exia on postoperative video-urodynamics but there was no evidence of stress incontinence. One patient had a bladder perforation on insertion of TVT, managed successfully with extended use of a urethral catheter post-operatively. Three patients developed post-operative urinary tract infection successfully treated with oral antibiotics. Conclusions: Tension-free vaginal tape insertion is minimally invasive, safe and e ective for the treatment of stress incontinence in females with bladder neuropathy with intrinsic sphincter de®ciency. Previous surgery for incontinence did not a ect post-operative complications or outcome.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders

Hamid

Khastgir

Arya³

et al. 2003

Spinal Cord

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“…The prolene tape (Ethicon) covered by a plastic sheet was used in all patients using the technique as described by Ulmsten et al 4 .…”

Section: Methodsmentioning

confidence: 99%

Short term complications of the tension free vaginal tape operation for stress urinary incontinence in women

Bodelsson¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To assess the prevalence of intra-and post-operative complications with the tension free vaginal tape operation for female urinary incontinence. Design Non-control case series.Setting University Hospital.Population One hundred and seventy-seven operations on women who were diagnosed urodynamically to have genuine stress incontinence. In 26 cases (15%) there was symptomatic urge incontinence. Main outcome measures Intra-and post-operative complications in relation to individual surgeons and mode of anaesthesia (local or spinal), and continence at short term follow up. Results Bladder or urethral perforation occurred in 26 cases (15%) and three operations were abandoned for these reasons. A failure to void after the first 24 hours was registered in 35 (20%); 21 (12%) had to undergo urethral dilatation while five patients (2.8%) had persistent urinary retention which required excision of the sling. These problems were significantly associated to the experience of surgeon. In seven cases (4%) haemorrhage required intravaginal tamponade. In three (1.7%) sling rejection occurred post-operatively. When followed up six to eight weeks post-operatively, 154 patients (88%) reported subjective cure, 21 (11%) significant improvement and two (1%) no improvement. The use of spinal anaesthesia increased the frequency of peroperative bladder perforation but affected neither the incidence of post-operative bladder obstruction nor the outcome at follow up. Conclusions This study identifies short term complications which relate partly to the experience of the individual surgeon. Nevertheless the 88% subjective cure rate was independent of these factors.

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“…Since the introduction of the midurethral tension-free vaginal tape (TVT) by Ulmsten and Petros [1995] [Ulmsten et al, 1996], it is estimated approximately 1 million cases have been performed worldwide. In addition, other techniques such as the suprapubic-arc sling (SPARC 1 ) which di¡ers from the TVT in the direction of trocar passage as well as the transobturator (TO) sling, have also gained popularity.…”

Section: Introductionmentioning

confidence: 99%

Presentation and management of major complications of midurethral slings: Are complications under‐reported?

Deng

Rutman

Raz

et al. 2006

Neurourology and Urodynamics

222

130

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Aims: Midurethral slings have become the mainstay of stress urinary incontinence (SUI) treatment due to their e⁄cacy and low complication rates. The purpose of this study was to report the presentation and treatment of major complications from these minimally invasive treatments presented to a tertiary referral practice and to highlight a discrepancy in major complications between literature and the food and drug administration (FDA) device failure database. Methods: From 2001 through 2005, we reviewed all cases of midurethral sling complications that presented to our institution. A literature review of all complications due to midurethral slings during the same time period was performed as was the FDA manufacturer and user facility device experience (MAUDE) database queried for self-reported complications. Results: A total of 26 patients referred to UCLA with voiding dysfunction after sling placement was found to have mesh in the urethra or bladder. Treatments required a combination of urethrolysis with mesh removal, urethral reconstruction with graft, and bladder excision. These were compared to major complications reported in the world literature of <1%. The MAUDE database contained 161 major complications out of a total of 928 complications reported for suburethral slings. There was signi¢cantly more major complications reported in MAUDE than in published literature. Conclusions: Although rare, major complications of midurethral slings are more common than appear in literature. Devastating complications involving urethral and bladder perforations can present with mild urinary symptoms and thus are likely under-diagnosed and under-reported. Most of these cases need to be managed with additional reconstructive surgery. Neurourol. Urodynam. 26:46^52, 2007. ß 2006

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An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence

Cited by 1,559 publications

References 9 publications

Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders

Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders

Short term complications of the tension free vaginal tape operation for stress urinary incontinence in women

Presentation and management of major complications of midurethral slings: Are complications under‐reported?

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