Tension-free vaginal tape: analysis of risk factors for failures

Abstract

To investigate whether there are any demographic, clinical, or urodynamic variables associated with an increased risk of failure in women undergoing surgery with tension-free vaginal tape (TVT). We retrospectively analysed 325 consecutive patients who had been operated with the TVT procedure. Patients were assessed with a complete history, physical examination, and urodynamic testing. The operation was done under local or epidural anesthesia and any further surgical procedure was added as indicated. The postoperative evaluation included collection of data on intra- and postoperative complications and analysis of outcomes. The outcome of surgical treatment was evaluated subjectively and objectively. The Statistical Package for Social Sciences (SPSS, Chicago, Illinois, USA) was used for data analysis; P<0.05 was considered significant. The overall complication rate was 14%, voiding dysfunction being the most common. Three hundred and one women were available for the analysis of surgical outcome and the mean follow-up was 34+12 months (median 32 months). Subjectively, 269 women (89%) were cured by the procedure and 13 (4.3%) reported marked improvement. An objective cure was achieved in 263 (87%); 38 patients still having leakage while coughing during postoperative cystometry. Among the numerous presumed risk factors for failed antiincontinence surgery only urethral hypomobility and recurrent stress urinary incontinence were significantly associated with failure of the TVT procedure in our study. However, even in these complicated situations, the cure rate was more than 70%.

Predictive factors that influence treatment outcomes of innovative single incision sling: comparing TVT-Secur to an established transobturator sling for female stress urinary incontinence

“…Previous incontinence surgery is a known risk factor for failure of MUS [2,15]. Meschia et al [2] reported a 72% cure rate in patients who underwent previous incontinence surgery vs. 89% in patients without a history of previous MUS, while high success rates have been established with TVT procedures in the latter group of patients [15].…”

“…However, there are a number of factors to take into consideration to determine the optimal surgical technique for the treatment of SUI. Patient demographics, urodynamic findings, history of previous pelvic or incontinence surgeries, and physical examination parameters are all important factors [2][3][4]. Most importantly, there are numerous MUS options based on the idea of supporting the urethro-vesical junction by placing a hammock-like structure under the urethra.…”

Advanced Diagnostic Testing for Female Pelvic Floor Dysfunctions

“…However, the differentiation of ISD from urethral hypermobility has been questioned, based on the lack of a validated, reliable and widely accepted marker for these conditions. Although lower preoperative MUCP has been associated with higher failure rates (48,49,50,52,53), there is increasing acknowledgement that procedures that were believed to be suitable for only ISD or urethral hypermobility are actually suitable for both types of SUI. TVT (traditionally used for urethral hypermobility) outcomes were found to be no different when stratified into ISD or hypermobility groups by MUCP or VLPP [36] and periurethral collagen injections (traditionally used for ISD) caused a 40-46% improvement in both ISD and urethral hypermobility on urodynamics [37].…”

“…La presenza di un deficit sfinterico intriseco è considerato un elemento prognostico sfavorevole nella chirurgia anti-incontinenza (48,49,50,51,52,53). La diagnosi di deficit sfinterico si fonda su due parametri urodinamici , non da tutti condivisi, di MUCP <20 cm H20 e VLPP <60 cm H20.…”

An adjustable sling in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape

“…9 Major complications are rare although reports of bleeding, urinary retention, de novo urgency, vaginal mesh extrusion, urethral erosion, abscess formation, vascular injury, nerve injury, and bowel injury have been reported. 10 There is a paucity of data on how to deal with recurrent stress incontinence after sling insertion.…”