Better Short-term Outcomes With the U-Method Compared With the Hammock Technique for the Implantation of the TVT-SECUR Under Local Anesthesia

Gagnon, Louis-Olivier; Tu, Le Mai

doi:10.1016/j.urology.2009.11.071

“…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.…”

Section: Discussionmentioning

confidence: 93%

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

Richard

¹

,

Gagnon

²

,

Tu

³

2012

CUAJ

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0

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Introduction: The TVT-Secur, a single incision sling, was introduced in 2006. It is implanted using either the "hammock" or the "U-method" technique. With the latter, the sling is tightened to create a "pillowing effect" on the urethra until a negative stress test is obtained. Short-term results seem promising. However, no study has ever reported on the voiding pattern 12 months after its implantation. Our objective was to assess whether the "U-method" technique creates an obstructive voiding pattern on pressure-flow study (PFS) 12 months after the surgery. Methods: In this retrospective study, we reviewed the charts of 33 women who underwent the "U-method" TVT-Secur. Patients were evaluated before and 12 months postoperatively with regard to different urodynamic studies (UDS). The incontinence status was also assessed 12 months after surgery. Results: At 12 months after the operation, 12.5% (4/32) of the patients reported an improvement of their stress urinary incontinence, while 78.1% (25/32) reported being cured from it. The objective cure rate was 63% (19/30 IntroductionSeveral treatment modalities exist for stress urinary incontinence (SUI), including pelvic floor physiotherapy and surgical interventions. The efficacy of the tension-free vaginal tape (TVT) has been demonstrated 1,2 and it is now considered the gold standard in the management of SUI. However, because of the blind passage of the needle through the retropubic space, it is associated with significant potential complications. 3 In 2001, transobturator tapes (TOT) were introduced to lower the number of bladder perforations and vascular injuries associated with TVT. 4 To further decrease the complication rate, the TVT-Secur (Gynecare, Ethicon, Somerville, NJ) was introduced in 2006. Two surgical techniques are presently used for its implantation: the "U-method" and the "hammock" method. 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. The objective of this study was to assess whether the 'U-method' creates an obstructive voiding pattern on the urodynamics studies (UDS) 12 months after implantation. MethodsAfter institutional review board approval, we reviewed the charts of 33 patients who underwent the implantation of the "U-method" TVT-Secur at our centre between October 2007 and April 2009. Charts were reviewed for incontinence status, urodynamic findings, subjective voiding symptoms and satisfaction rate. Preoperat...

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“…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.…”

Section: Discussionmentioning

confidence: 93%

“…Two surgical techniques are presently used for its implantation: the "U-method" and the "hammock" method. 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.…”

Section: Introductionmentioning

confidence: 96%

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

Richard

¹

,

Gagnon

²

,

Tu

³

2012

cuaj

Self Cite

2

0

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Introduction: The TVT-Secur, a single incision sling, was introduced in 2006. It is implanted using either the "hammock" or the "U-method" technique. With the latter, the sling is tightened to create a "pillowing effect" on the urethra until a negative stress test is obtained. Short-term results seem promising. However, no study has ever reported on the voiding pattern 12 months after its implantation. Our objective was to assess whether the "U-method" technique creates an obstructive voiding pattern on pressure-flow study (PFS) 12 months after the surgery. Methods: In this retrospective study, we reviewed the charts of 33 women who underwent the "U-method" TVT-Secur. Patients were evaluated before and 12 months postoperatively with regard to different urodynamic studies (UDS). The incontinence status was also assessed 12 months after surgery. Results: At 12 months after the operation, 12.5% (4/32) of the patients reported an improvement of their stress urinary incontinence, while 78.1% (25/32) reported being cured from it. The objective cure rate was 63% (19/30). One patient had a suspected bladder outlet obstruction (BOO) based on PFS. Maximal flow rate (Q max ) was significantly lower 12 months after surgery (

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“…Gagnon and Tu reported that improvement in incontinence symptoms was much higher with the U Method than with the Hammock technique [14]. The success rate increased with time, reaching a statistically significant difference at 6 months with 100% (22/22) improvement compared with 69% (11/16) for the Hammock technique.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of the TVT-SECUR® and Impact on Quality of Life in Women with Stress Urinary Incontinence: A 2-Year Follow-Up

Shin

¹

,

Seong

²

,

Cheon

³

et al. 2011

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PurposeAs recently reported, the short-term results of the tension-free vaginal tape SECUR® (TVT-S) procedure seem to be similar to those of the conventional transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are insufficient in patients with more than 1 year of follow-up. Therefore, we evaluated the results of the TVT-S procedure in women with stress urinary incontinence (SUI) during 2 years.Materials and MethodsWe evaluated 51 patients with clinical and urodynamic diagnoses of SUI who underwent the TVT-S procedure from March 2008 to February 2009. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) questionnaire. Following the postoperative period, urinary incontinence status was examined through a physical examination and the I-QoL questionnaire was completed in an outpatient setting or by telephone.ResultsData from 2 years of follow-up were available for 46 of 51 patients. The cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S. The mean total I-QoL score increased by 42 points at 1 month after TVT-S (p<0.026) and by 32 points at 2 years after TVT-S (p<0.013). Most patients reported significant improvements in quality of life. At the 2-year follow-up, there were no significant complications related to TVT-S.ConclusionsThe results of this study suggest that TVT-S is an efficient and safe procedure for the improvement of both the quality of life of the patients and the SUI itself.

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Better Short-term Outcomes With the U-Method Compared With the Hammock Technique for the Implantation of the TVT-SECUR Under Local Anesthesia

Cited by 14 publications

References 14 publications

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

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

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

Efficacy and Safety of the TVT-SECUR® and Impact on Quality of Life in Women with Stress Urinary Incontinence: A 2-Year Follow-Up

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