Randomized Comparative Study of the U- and H-Type Approaches of the TVT-Secur Procedure for the Treatment of Female Stress Urinary Incontinence: One-Year Follow-Up

Abstract

PurposeWe compared outcomes of the U- and H-type approaches of the tension-free vaginal tape (TVT)-Secur procedure for the treatment of female stress urinary incontinence (SUI).Materials and MethodsFrom March 2007 to July 2008, 115 women with SUI underwent TVT-Secur by a single surgeon. Patients were randomly assigned to either the U- or the H-type approach. After 12 months, postoperative changes in the Sandvik questionnaire, incontinence quality of life questionnaire (I-QoL), Bristol female lower urinary tract symptoms-scored form (BFLUTS-SF), and postoperative patient satisfaction were evaluated. Cure was regarded as no leakage on the Sandvik questionnaire. Complications were also evaluated.ResultsOf 115 women, 53 were treated with the U approach, and 62 women were treated with the H approach. At 12 months, 88.7% of those treated with the U approach and 87.1% of those treated with the H approach were cured (p=0.796). The I-QoL and filling, incontinence, sexual function, and QoL sum (BFLUTS-SF) scores were improved with both approaches, and there were no significant differences in the degree of improvement between approaches. Approximately 83.7% and 82.9% of the women treated with the U and H approaches, respectively, were satisfied with the outcome (p=0.858). There were 3 cases of intra-operative vaginal wall perforation in the H-type group. Immediate postoperative retention was observed in 2 women in the U-type group and 1 woman in the H-type group. One woman in the U-type group underwent tape releasing and cutting procedures for persistent large post-void residuals.ConclusionsThe U- and the H-type approaches of the TVT-Secur procedure provided comparable effectiveness for the treatment of female SUI.

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women

“…This cure rate fell down to 85% at the end of a year, due to vaginal tape exposure, requiring sectioning of the tape in 2 patients. Other centres implanting TVT-Secur have published cure rates of 77.2% at 4 months as by Mossa et al, 6 to 78-81% by Meschia et al 7 and Walsh, 8 and to 87.1% by Kim et al 9 Even lower cure rates of 68.2% at one year have been reported by Joo et al 10 Han et al 11 on the other hand have cited that the overall success rate after TVT-Secur implantation was maintained over a period of 3 years although the cure rate fell down to 72.9%. Cure rates with other mini-slings like Mini-Arc have ranged between 80 and 92% at the end of one year, as per the studies by Annett et al 12 and by Daneshgari et al 13 The improvement in the patient satisfaction and Incontinence specific QOL scores, as measured by Mann-Whitney U test of both UDI-6 and IIQ-7, was statistically significant at 95% and 99% confidence levels.…”

Single-Incision Slings (SIS) - a New Option for the Surgical Treatment of Female Stress Urinary Incontinence

“…In the, up to now, entirely tension-free TVT insert, particularly the TVT Secur showed considerably poorer results; a significant improvement in the continence rate was observed only with the introduction of a less tension-free insertion of the tape with contact to the urethra and without additional interspace. The data available from the literature vary between 40 and 87 % [14][15][16][17][18][19][20]. Investigations in our own hospital showed a continence rate of 63 %, with 23 % improvement.…”

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

“…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.…”

“…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.…”

“…23 Hsiao and colleagues compared the preoperative and postoperative UDS in patients who underwent the TVT or TOT (Monarc) procedures. 24 No significant differences were observed between both procedures with regard to their impact on bladder voiding and storage functions, although the TOT did lower the Q max (-2.4 mL/s) on the 12-month follow-up UFM.The success rate of the TVT-Secur is generally between 58% and 85%, [6][7][8][9][10][11]15,16,25 although a success rate as high as 94.6% has been reported. 9 Its success rate is generally lower than the more conventional slings, with success rates around 90% to 92% for the TVT and between 87% and 90% for the TOT.…”