Tension-free vaginal tape operation: results of the Austrian registry

Tamussino, Karl; Hanzal, Engelbert; Kölle, D.; Ralph, G.; Riss, P.

doi:10.1016/s0029-7844(01)01565-4

Cited by 156 publications

(101 citation statements)

References 11 publications

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“…Was anaesthetic time included in this, and if so was regional anaesthesia always used for both procedures? Clearly if anaesthetic time was included but some cases were performed under general anaesthesia, this would have an impact on operating times overall.We were somewhat surprised by the number of reoperations (30%) in the TVT SUI 1 group, which is high compared to other published data [2,3]. If only 4 of the 15 reoperations were for tape section and 3 for draining haematomas, the indications for the remaining 8 operations were not clearly stated.…”

contrasting

confidence: 55%

Comments on Araco et al.: TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence

2008

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Dear Editor, We read with interest the paper by Araco et al. on a randomised trial of TVT-O versus TVT in patients with different degrees of urinary stress incontinence [1]. We compliment the authors on their rigorous trial design. We would, however, respectfully request clarification on a few points.The operating time for TVT-O was significantly shorter than for TVT, but details on the anaesthetic were given only for one arm. Was anaesthetic time included in this, and if so was regional anaesthesia always used for both procedures? Clearly if anaesthetic time was included but some cases were performed under general anaesthesia, this would have an impact on operating times overall.We were somewhat surprised by the number of reoperations (30%) in the TVT SUI 1 group, which is high compared to other published data [2,3]. If only 4 of the 15 reoperations were for tape section and 3 for draining haematomas, the indications for the remaining 8 operations were not clearly stated. If 5.5% of TVT patients had surgery for early postoperative haematomas, this is a higher rate than in previously published reports (0.7%-1.9%) [2,3]. Do the authors have any explanation why surgical drainage rather than conservative management was chosen, or further information regarding the volume of haematoma and the drop in haemoglobin?The authors state that there was no significant difference in reoperation rates between the TVT and TVT-O groups or between the SUI 1 and SUI 2 groups. However, we think that even if this was true at 1-year follow-up, the TVT SUI 1 group was more likely to require early reoperation for complications than the TVT-O SUI 1 group and the subjects in the TVT-O SUI 2 group were more likely to need a second continence procedure than all other groups.Finally, stratification in a randomised controlled trial has many advantages, as demonstrated in this study, including avoiding confounding, and providing credibility to the choice of analysis covariates. One has to be aware, however, that there is more opportunity to introduce error and that the gain in precision of estimate of effectiveness is small once the number of subjects per treatment is over 50 [4]. An alternative method of obtaining comparable groups is minimisation.Despite these points we would congratulate the authors on their excellent study and look forward to their 2-and 5-year follow-up data. References

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contrasting

confidence: 55%

Comments on Araco et al.: TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence

2008

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“…Üriner inkontinansı olan kadınların %80'inde pelvik organ prolapsusu olduğu bilinmektedir ve stres inkontinans nedeniyle operasyon geçireceklerin %41'inin pelvik organ prolapsus cerrahisine ihtiyacı olduğu hesaplanmıştır (25,26). Bu cerrahi işlemlerden en sık uygulananı da sistosel onarımıdır.…”

Section: Bulgularunclassified

Anterior Colporrhaphy Technique and Approach Choices: Turkey Evaluation

Aydın¹,

Bakar²,

Batmaz³

et al. 2016

Haseki

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ÖzAmaç: Türkiye'de anterior vajinal duvar cerrahisi ile ilgilenen cerrahlar arasındaki anterior kolporafi tekniklerindeki ve yaklaşımlarındaki farklılıkları değerlendirmektir. Yöntemler: Preoperatif muayeneyi, anterior kolporafi tekniğini, operasyon tercihlerini ve postoperatif bakımı değerlendiren anket cerrahlara sunuldu. Direkt olarak, elektronik posta, telefon veya anlık mesajlaşma ile iletişime geçildi. Yirmi sekiz soruluk anketi kullandık. Data analizi yapıldı ve frekanslar hesaplandı. Bulgular: Anketi tamamlayan 116 kişi vardı. Büyük bir kısmını (%87,9) genç jinekologlar oluşturuyordu. Ürologlar çalışma popülasyonunun %9,5'ini oluşturuyordu. Paravajinal defekti değerlendirme oranı %75,9'du ve çoğunlukla rugaların izlenmesi ile değerlendiriliyordu. Transperineal 3D pelvik taban ultrasonografi kullanımı düşüktü (%5,7). Levator ani kas hasarını değerlendirme oranı %46,6 idi. Levator ani kas defekti için transperineal ultrasonografi kullananlar cerrahlar %19'du. Hidrodiseksiyon kullanımı, fasya plikasyonu, fazlalık vajina mukozasının çıkartılması ve sütur tercihleri konusunda farklılıklar mevcuttu. Anterior kolporafi için meş kullanımı nadir (%17,8) olup, çoğunlukla (%12,2) nüks olgularında kullanılıyordu. Paravajinal defekt onarımı yapanlar anketi cevaplayanlar içinde %31,9'du. Üriner kateter genellikle birinci veya ikinci gün çıkartılıyordu. Vajinal tampon genellikle operasyondan 24 saat sonra çıkartılıyordu. Sonuç:Türkiye'deki operatörler arasında anterior vajinal duvar onarımı teknikleri ve yaklaşımları çeşitlilik göstermektedir. Teknikler arasındaki bu farklılıklar en iyi cerrahi teknik konusunda fikir birliği olmadığını düşündürmektedir. Teşhis için kullanılan teknolojinin gelişimi ile birlikte operasyon seçenekleri de değişebilir. Anahtar Sözcükler: Kolporafi anterior, anterior vajinal duvar prolapsusu, sistosel, meş, paravajinal defekt onarımı Aim: To evaluate the diversity in techniques and approaches for anterior colporrhaphy among operators in Turkey. Methods:A survey evaluating the preoperative examination, technique of anterior colporrhaphy, operation choice and postoperative care was presented to surgeons. We contacted via directly, mail or telephone. We used 28 item questionnaire.Results: Majority (87.9%) was composed of young gynecologists. Urologists composed of the 9.5% of the study population. The rate of paravaginal defect evaluation was 75.9% and mostly by inspection the presence of vaginal rugae. The use of transperineal 3D pelvic floor ultrasonography was low (5.7%). The evaluation of levator ani muscle defect was 46.6%. The usage of the transperineal 3D ultrasonography for levator ani muscle defect was 19 percent of operators. There were diversity in use of hydrodissection, fascial plication, excision of vaginal mucosa and suture choice. Usage of mesh for anterior colporrhaphy was limited (17.8%) and mostly in recurrent cases (12.2%). Paravaginal defect repair rate was 31.9%. The urinary catheter was generally removed one or two day after operation. Vaginal pack usually removed 24 hour...

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“…Perforation of the bladder (up to 11.6%) [4,7,8,21,22,23] and bleeding (up to 3.3%) [9,21,22,24] are the most common complications seen during surgery. Voiding difficulty (up to 17%) [4,21,22,23] is the most common postoperative complication, which Fig.…”

Section: Treatment Of Complicationsmentioning

confidence: 99%

“…Now, the TVT needle is pushed around the symphysis in a straight, sagittal direction and the top of the needle is pierced through the skin of the mons pubis Fig. 6 The top of the needle has to touch the backside of the symphysis, respectively the pubis, to prevent lesions of the bladder often leads to reoperation [24]. If the sling is placed too tightly around the urethra (Fig.…”

Section: Treatment Of Complicationsmentioning

confidence: 99%

Tension-free vaginal tape (TVT): our modified technique—effective solutions for postoperative TVT correction

et al. 2004

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Tension-free vaginal tape (TVT) is nowadays an established operation for the treatment of stress urinary incontinence. In this article, we will demonstrate our standardized TVT procedure and ways of possible postoperative correction. A tight vaginal tape can be individually expanded by a Prolene-interponate within days and also years after surgery. On the other hand, we developed a technique to shorten a loose vaginal tape. Moreover, we will discuss our approaches in the case of an eroded Prolene tape, local estrogen therapy, tape padding with vaginal tissue and blunt removal of the tape by a small vaginal incision.

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Tension-free vaginal tape operation: results of the Austrian registry

Abstract: The tension-free vaginal tape has become a frequently performed operation in Austria. There are considerable variations in clinical practice. The risk of bladder perforation was increased in patients with previous surgery. Severe complications were rare.

Cited by 156 publications

References 11 publications

Comments on Araco et al.: TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence

Comments on Araco et al.: TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence

Anterior Colporrhaphy Technique and Approach Choices: Turkey Evaluation

Tension-free vaginal tape (TVT): our modified technique—effective solutions for postoperative TVT correction

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