Funneling before and after anti-incontinence surgery—a prognostic indicator? Part 2: tension-free vaginal tape

Abstract

Does the presence of pre- and postoperative funneling of the proximal urethra affect the outcome of tension-free vaginal tape (TVT)? This prospective study of 191 women with proven primary genuine stress urinary incontinence treated by TVT insertion and assessed by pre- and postoperative introital ultrasound aims to answer that question. At 36-month follow-up, the cure rate was 89.5% (Kaplan-Meier estimator). At 6-month follow-up, 6.3% of the women had urge symptoms and 0.5% de novo urge incontinence. The cure rate in preoperative funneling was 77.5% as opposed to 96.6% in the group without funneling (P<0.0001). The funneling rate significantly decreased from 37.2% preoperatively to 17.3% immediately postoperatively (P<0.0001). The continence rate was 57.5% in persistent postoperative funneling vs 96.2% in the group without postoperative funneling (P<0.0001). The complication rate was not higher in the group with persistent postoperative funneling. The TVT procedure significantly reduces bladder neck funneling. Both preoperative and persistent postoperative funneling are associated with an increased probability of therapeutic failure or recurrence.

Tape functionality: Sonographic tape characteristics and outcome after TVT incontinence surgery

“…2,4,9 The present study demonstrates that both a vaginal tape too far away and too close to urethra lead to specific sonographic tape appearances and result in reduced success rates and increased complication rates. As we observed that under Valsalva the tape very often acquires a c-shape on US we speculate that c-shape indicates that tension is exerted on the TVT.…”

“…Introital US was performed under standardized conditions using a vaginal 5-9 MHz probe of Ultramark HDI C9-5 ICT (ATL, Hamburg, Germany) with pressure-free probe application. 2,3,9 US was performed according to the guidelines for performing lower urinary tract US as part of urogynecologic functional assessment issued by the German Association of Urogynecology. 4 With the patient in the semi-sitting position and a standardized bladder volume of about 300 ml, the US probe was positioned in the area of the vaginal introitus at the external urethral orifice without applying pressure and aligning the axis of the probe to the patient's long body axis (i.e., in coronal and sagittal planes) by one experienced sonographer.…”

“…Ultrasound (US) together with history, clinical examination and urodynamics, it has been shown to improve the accuracy of the diagnosis of the functional and morphological disorders of the lower urinary tract. [2][3][4][5] US studies have shown that the TVT procedure neither changes hypermobility nor elevates the bladder neck. 6 TVT insertion is supposed to be a midurethral procedure; however postoperative US shows that position and mobility of the TVT relative to bladder neck vary markedly, according to Dietz et al 7 with relatively little effect on success and symptoms.…”

Bladder neck evaluation by perineal ultrasound before and after reconstructive surgery for pelvic organ prolapse

“…Therefore, it is possible that these procedures were effective in interrupting the recurrence of SUI, particularly for the cases with high FI values. On the other hand, in the cases of tensionfree vaginal tape (TVT) surgery for UI, it was reported that a high recurrence rate of SUI was observed post operation when funneling was observed by PUS before surgery [13]. Since TVT provides support to the mid-urethra, and the Kelly suture technique is used to repair the urethra-vesical junction [14], the control mechanisms for SUI provided by each technique may be different.…”

Intérêt de l’échographie dans le suivi des patientes après promontofixation par cœlioscopie : étude préliminaire

“…6). On sait maintenant grâce à l'ultrason diagnostiquer et orienter le traitement de complications de bandelettes [22][23][24]. Le polypropylène tricoté est le matériau le plus cité dans ces publications.…”