Do different vaginal tapes need different suburethral incisions? The one-half rule

Viereck, Volker; Kuszka, Andrzej; Rautenberg, Oliver; Wlaźlak, Edyta; Surkont, Grzegorz; Hilgers, Reinhard; Eberhard, Jakob; Kociszewski, Jacek

doi:10.1002/nau.22658

Cited by 20 publications

(55 citation statements)

References 28 publications

(69 reference statements)

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“…After the operation most of the women had normobile and hypermobile urethra. It is important because hypomobile urethra is a risk factor for failure after operative treatment of stress urinary incontinence after suburethral sling [9,16]. Thus, in our opinion, we should avoid procedures that have negative influence on urethral mobility.…”

Section: Discussionmentioning

confidence: 97%

“…Mobility of the urethra and urethral funneling with urine flow were evaluated [9,[15][16][17]. Urethral mobility was evaluated as vector calculated from measurements obtained during PFS-TV according to the method specified by Viereck.…”

Section: Methodsmentioning

confidence: 99%

“…This parameter is called linear dorsocaudal movement (LDM) [16,17]. Lately hypomobile urethra was defined as value of the LDM ≤ 5 mm, normobile: 5-15 mm, hypermobile: ≥ 15 mm [9,16]. Hypomobility of the urethra is one of the risk factors for failure after suburethral sling implantation [9,16].…”

Section: Methodsmentioning

confidence: 99%

“…Lately hypomobile urethra was defined as value of the LDM ≤ 5 mm, normobile: 5-15 mm, hypermobile: ≥ 15 mm [9,16]. Hypomobility of the urethra is one of the risk factors for failure after suburethral sling implantation [9,16]. Urethral funneling with urine flow, observed during PFS-TV, is regarded as confirmation of stress urinary incontinence [15].…”

Section: Methodsmentioning

confidence: 99%

“…It is also often used to evaluate women with stress urinary incontinence before and after suburethral sling implantation [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

Kluz

Wlaźlak²,

Surkont³

2017

Ginekol Pol

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Objectives: Analysis of feasibility, efficacy and short-term results after six-arm transvaginal mesh OPUR implantation in women with apical prolapse. Material and methods:The same surgeon operated all of 39 women using mesh OPUR. Preoperatively patients had a standardized interview and clinical examination. Intraoperative and postoperative complications were analyzed. Postoperative evaluation included standardized interview, clinical examination and standardized pelvic floor ultrasound performed with 2D transvaginal probe and 4D abdominal probe.Results: There was no complication that needed operative intervention. Hematomas in 3 patients resolved spontaneously. Transient voiding difficulties which lasted less than 7 days were observed in 5 patients. No erosion was observed. Comparison of pre-and postoperative results in 34 women revealed that in all 3 compartments improvement in POP-Q scale was statistically significant (p < 0.0000). One patient with malposition and rolled up mesh needed re-operation. During PFS-TV in 94.1% of patients urethra was normobile or hypermobile. In all of the patients urethral end of the mesh was positioned far enough from the middle part of the urethra (ultrasound) to implant suburethral sling without risk of collision. Sexually active women did not inform of any important discomfort or pain during intercourse. Conclusions:It seems that six-arm OPUR mesh, if implanted under strict surgical rules, gives low risk of complications and high chance to successfully reduce POP symptoms in short term after the operation. It seems that OPUR mesh should not have negative influence on the results after anti-incontinence suburethral sling.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…It is also often used to evaluate women with stress urinary incontinence before and after suburethral sling implantation [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

Kluz

Wlaźlak²,

Surkont³

2017

Ginekol Pol

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Use of intraoperative ultrasound to improve tension‐free vaginal tape‐obturator placement: A pilot study

González-Díaz

Fernández-Llamas

Corral

et al. 2023

Intl J Gynecology & Obste

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Objective To evaluate the use of intraoperative ultrasound (IUS) to achieve a postoperative optimal placement of the tension‐free vaginal tape‐obturator (TVT‐O). Methods A cohort study was performed among women who underwent TVT‐O placement. In 25 women, ultrasound was used for the placement, and based on current evidence, the optimal intraoperative and postoperative ultrasound pattern was selected. They were compared with 25 women where IUS was not used. Results IUS increased operative time (by 7.5 min), and in 36% (9/25) of cases it was necessary to perform some corrections based on the ultrasound findings. After 1 month, in patients of the IUS group, the tapes were more frequently placed at a distance of 3–5 mm (P = 0.01), and it was more common for it to be placed between 40% and 70% relative to the urethral length (P = 0.011). Of tapes placed with IUS, 76% (met the optimal postoperative ultrasound pattern, as opposed to only 48% placed without IUS (P = 0.041). No differences were found in the complications or the functional results at 1 month post‐surgery. Conclusion The use of IUS for the placement of TVT‐O allows us to position them optimally and avoid erroneous placements, although IUS increases the operative time without improving the functional results and the rate of complications.

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Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure

Zivanovic

Rautenberg

Lobodasch

et al. 2016

Neurourology and Urodynamics

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Aims: To assess the effectiveness of a polyacrylamide hydrogel (PAHG; Bulkamid 1 ) in treating recurrent stress urinary incontinence (SUI) following a previous midurethral sling (MUS) implant. Methods: This observational study, conducted since 2009, included 60 patients with recurrent SUI or mixed urinary incontinence (MUI) after a previous MUS and who chose to be treated with PAHG. Objective and subjective outcomes were assessed at 1, 6, and 12 months after the initial injection. Patients were classified as cured based on a negative cough test (supine and standing) and <2 g urine on 1-hr pad test and a VAS score improved by !90%. Improved were those with the loss of only a few drops of urine during the cough test and 2-10 g urine on 1-hr pad test or a reduction >50% compared with preoperative urine loss and a VAS score improved by !75%. Results: The volume of PAHG injected in the current study ranged from 1-3 ml. Cured/improved rates were 93.3% (56/60), 88.3% (53/60), and 83.6% (46/55) at 1, 6, and 12 months, respectively. Patients with MUI had a cured urgency urinary incontinence rate of 36.8%, 47.4%, and 38.9%, respectively. Voiding dysfunction rates were 13.3% (8/60), 8.3% (5/60), and 1.8% (1/55) at 1, 6, and 12 months and urinary tract infection rates were 5% (3/60), 11.7% (7/60), and 3.6% (2/55), respectively. Other adverse events were short-term and/or observed in <4% of patients. Conclusions: PAHG can be used to treat recurrent SUI after MUS failure with good outcome and low complication rates. Neurourol.

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Do different vaginal tapes need different suburethral incisions? The one-half rule

Abstract: When surgically treating SUI with a TOT, incision at the mid-urethra using the 1/2 rule is recommended as it leads to better outcomes for most patients, particularly those with normal urethral mobility.

Cited by 20 publications

References 28 publications

Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

Use of intraoperative ultrasound to improve tension‐free vaginal tape‐obturator placement: A pilot study

Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure

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