How does tension-free vaginal tape correct stress incontinence? Investigation by perineal ultrasound

Abstract

Forty patients who underwent a single tension-free vaginal tape procedure were evaluated by perineal ultrasound both pre- and postoperatively in a prospective observational clinical study. The positions of the tape, bladder neck and urethra were sonographically documented at rest and during Valsalva maneuvers. During Valsalva the tape rotated towards the symphysis in all patients. Postoperative urethral angulation could be demonstrated in 36 of 40 patients. Bladder neck mobility remained unchanged after the tension-free vaginal tape procedure, and 36 of the 40 were dry according to patient questionnaires. Postoperative cough test was negative in all patients. Two points seem to be important for the functioning of the tension-free vaginal tape: a dynamic kinking of the urethra during stress, and the movement of the tape against the symphysis, compressing the tissue between the tape and the symphysis. Mobility of the bladder neck is unaffected by the single tension-free vaginal tape procedure.

Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy

“…The transducer was placed on the perineal area in a sagittal orientation, to obtain images of the pubic symphysis, bladder, bladder neck and urethra (13,16). Ultrasound assessment of the male bladder is best achieved when the urine volume is at least 300 mL.…”

“…If a subject -particularly in the incontinent group -was unable to maintain this volume, an infusion of 0.9% normal saline via Foley catheter was performed. The catheter was promptly removed before measurements were obtained (8,16).…”

“…We calculated the anterior and the posterior bladder neck mobility under conditions of rest, pelvic floor contraction and Valsalva maneuver. The movement of the bladder neck was calculated by the following formula: √(x2-x1)²+(y1-y2)², where x1 and y1 represent the rest coordinates (8,9,(16)(17)(18)(19) (Figure 2).…”

“…Incontinent patients were stratified according to the degree of incontinence as measured using the 24h Pad test: light: 0-100g; moderate: 100-400g; severe >400g) (16,17). Urinary tract infections were ruled out by urine culture in all subjects prior to the ultrasound examination.…”

Perioperative evaluation of anatomy of urinary bladder and urethra in ultrasound examination of female patients operated due to urinary stress incontinence

“…W swym badaniu Tsia-Shu i inni nie odnotowali różnicy w ruchomości szyi pęcherza moczowego przed operacją i po zabiegu [11]. Podobnie Sarlos i Schaer nie odnotowali zmniejszenia ruchomości cewki moczowej i szyi pęcherza moczowego, a efekt działania taśmy wiązali z zagięciem cewki moczowej i zbliżaniem się taśmy do spojenia łonowego [12]. Jednak w obydwu tych przypadkach autorzy badali zmianę anatomii po operacji taśm zakładanych załonowo (TVT) w przeciwieństwie do niniejszej pracy (91% pacjentek miało wykonaną operację przezzasłonowo [TOT]).…”