Short‐term assessment of a tension‐free vaginal tape for treating female stress urinary incontinence

Oliveira, Rui; Silva, André; Pinto, Rui; Silva, João; Silva, Carlos; Guimarães, M.; Dinis, Paulo; Cruz, Francisco

doi:10.1111/j.1464-410x.2008.08330.x

Cited by 35 publications

(30 citation statements)

References 25 publications

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“…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. 11 Only one patient (3%) reported UUI 12 months after surgery, which is lower than the rates in previous studies which varied from 7% to 12%. 10,16,25 One patient (3%) was still complaining of pain 12 months after surgery.…”

Section: Discussioncontrasting

confidence: 57%

“…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.…”

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confidence: 99%

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

Richard

Gagnon

2012

CUAJ

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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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Section: Discussioncontrasting

confidence: 57%

mentioning

confidence: 99%

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

Richard

Gagnon

2012

CUAJ

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“…Urodynamic stress incontinence was confirmed before surgery in all cases. The surgical approach was specified in six studies, with 62% (488/784) undergoing the 'H-type' and 38% (296/784) undergoing the 'U-type' approach (Table 2 [6][7][8][9][10][11][12][13][14][15]). …”

Section: Resultsmentioning

confidence: 99%

“…The mean operating time for TVT-S in the included studies was 17 min, with a negligible average blood loss of 36 mL (Table 3 [6][7][8][9][10][11][12][13][14][15]). The overall rate of recognized intra-operative vaginal perforation was 1.5% (15/998).…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of de novo OAB symptoms after TVT-S procedures was 10% (84/832). Only 1% of women reported dysparuenia or groin/leg pain at 12 months (Table 4 [ [6][7][8][9][10][11][12][13][14][15]). Although < 1% of women returned to the operating theatre because of a complication, 5% (43/ 799) of patients underwent a repeat surgical procedure for SUI in the first year after a TVT-S procedure.…”

confidence: 99%

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TVT‐Secur mini‐sling for stress urinary incontinence: a review of outcomes at 12 months

Walsh¹

2011

BJU International

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What’s known on the subject? and What does the study add?Although synthetic mid‐urethral slings are now generally accepted as the first‐line surgical treatment of female stress incontinence, there is concern that newer slings are being used prematurely, before sufficient evidence exists. The 3rd generation “mini‐slings” are inserted via a single incision which, theoretically, reduces iatrogenic morbidity. It is vital, however, that efficacy is not compromised. To date, a number of papers have examined short‐term outcome data following the TVT‐Secur, with wide variations in reported cure rates at up to one year.This is the largest review of outcomes following TVT‐Secur published to date (n= 1178 cases from 10 studies). Cure rate, both objectively and subjectively, was 76%, which is similar to more established mid‐urethral slings. Intra‐operative vaginal perforation rates and rates of mesh exposure in the first 12 months post‐operatively were both 2%. The incidence of de novo OAB was 10%. No serious complications were recorded amongst this large cohort. Although the TVT‐Secur appears to be a safe procedure, its long‐term efficacy moving forward requires close scrutiny.• Synthetic mid‐urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single‐incision mini‐slings. The present paper is a systematic review of studies reporting 12‐month outcomes after the TVT‐Secur (TVT‐S) procedure.• Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled‐trials.com online trial registries were searched for English‐language articles containing the terms ‘TVT‐Secur’, ‘TVT Secur’ or ‘mini‐sling’. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri‐operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates.• Among 1178 women undergoing the TVT‐S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the ‘U‐type’ approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT‐S procedure 5% of women required repeat continence surgery.• Longer‐term studies and randomized comparisons with more established MUSs are required before TVT‐S should be routinely used in the surgical treatment of stress urinary incontinence.

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