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

Abstract

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...