Bladder injury and success rates following retropubic mid-urethral sling: TVT EXACT™ vs. TVT™

Postoperative PFME versus PFME alone for moderate SUI in pre-menopause women and influencing factors: a comparative effectiveness study

PURPOSE

To explore the effectiveness of sling surgery followed by pelvic floor muscle exercises (PFME) or PFME alone for moderate stress urinary incontinence (SUI) in women and its influencing factors.

METHODS

This is a prospective observational cohort study investigating whether sling surgery or PFME is preferred for pre-menopause women with moderate uncomplicated SUI. Those who received PFME alone or sling surgery were divided to PT or TVT group, respectively. The primary outcome was objective cure at 12 months. The secondary outcomes included Incontinence Impact Questionnaire-Short Form (IIQ-7) scores and PFME adherence.

RESULTS

The study sample comprised 130 and 74 patients in the PT and TVT groups, respectively. There was 38.2% of patients adhered to PFME twice weekly or more often, and the compliance varied by education level. At 12 months, the objective cure rate was significantly higher in the TVT versus PT group (75.7% vs 47.7%; adjusted OR = 4.27; 95% CI, 2.05-8.87; P < 0.001). In addition, the mean reduction in IIQ-7 scores was greater in the TVT group (16.2 vs 10.0; adjusted OR = 3.38; 95% CI, 1.93-4.82; P < 0.001). However, among patients with lower education or those without adherence to PFME at 12 months, the TVT was also favorized, and the discrepancy in cure rates was greater between the two groups.

CONCLUSION

Sling procedures followed by PFME demonstrate greater efficacy versus physiotherapy alone for moderate female SUI management. Continued adherence to PFME was important, even for patients undergoing sling procedures. Educational factors influenced patient PFME adherence and the advantage conferred by sling procedures.

Sonographic assessment of compression effect on urethra following transobturator MUS

INTRODUCTION AND HYPOTHESIS

The aim of this study was to investigate the relationship between compression effect exerted by the sling on the urethra using translabial ultrasound and the prognosis of sling surgery in women for stress urinary incontinence (SUI).

METHODS

We retrospectively reviewed 151 women with SUI who had undergone either a TVT-Abbrevo (n = 81) or TVT-O (n = 70) procedure. Preoperative and 12-month postoperative assessments including sonographic data, urinary symptoms and signs were compared. Objective and subjective success rates were assessed at 12 months postoperatively.

RESULTS

Overall, 140 patients (92.7%) were objectively cured and 138 patients (91.4%) were subjectively cured of SUI 12 months after the operation with no significant differences between groups (p > 0.05). After both the TVT-Abbrevo and TVT-O procedures, the shortest distance between the tape and the urethral cavity line (TU) on straining (objective cure 4.1 mm vs. 4.5 mm, subjective cure 4.1 mm vs. 4.4 mm), the changes of the angle (∆) between the two arms of the sling (objective cure 15.8° vs. 20.8°, subjective cure 16.5° vs. 21.3°) and the gap between the sling and symphysis pubis (objective cure 9.9 mm vs. 12.1 mm, subjective cure 9.8 mm vs. 12.4 mm) were significantly smaller in the success group (p < 0.05). Analysis of ultrasound measurements in women reporting success and those reporting failure of the procedure showed the ∆TU (objective cure 1.6 mm vs. 0.9 mm, subjective cure 1.6 mm vs. 1.0 mm) and the angle on straining (objective cure 93.4° vs. 89.2°, subjective cure 94.3° vs. 88.9°) to be significantly bigger (p < 0.05). However, none of the assessed sonographic variables showed any significant differences between the TVT-Abbrevo and TVT-O groups.

CONCLUSIONS

The change in distance between the tape and urethral cavity line in the center of the urethra in the mid-sagittal plane after straining is an effective indicator of the compression effect exerted by the sling on the urethra after a mid-urethral sling (MUS) procedure and may contribute to both objective and subjective cure rates postoperatively.

Complications and re-operations after tension-free vaginal tape operation in women with stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

We evaluate intraoperative and short-term postoperative (≤ 3 months) complications and long-term re-operations (up to 6 years) after tension-free vaginal tape (TVT) operation in women with stress urinary incontinence (SUI).

METHODS

Data from 446 women undergoing TVT operation between 2012 and 2016 at a tertiary referral center was retrospectively collected. Data included patient baseline demographics, information from the TVT operation and the following postoperative period, and scores from patient questionnaires [the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Patient Global Impression of Improvement (PGI-I)]. Collected data were investigated for incidence of complications and re-operations, postoperative improvement in patient questionnaires, and association between complications and baseline patient demographics.

RESULTS

The only intraoperative complication was bladder perforation (2.0%). Postoperative complications included: infection (0.7%), hematoma (0.9%), bleeding (0.2%), pain (0.9%), erosion of the vaginal mucosa (1.1%), persistent SUI (0.7%), and voiding dysfunction > 24 h (10.3%). Re-operations included: operation due to infections (0.4%), incontinence surgery for persistent SUI (0.4%), revision for tape erosion (1.1%), tape mobilization (3.6%), and tape division (0.2%). A significant reduction in urinary incontinence symptoms was observed in the ICIQ-UI SF and PGI-I. The reduction in ICIQ-UI SF did not vary significantly between patients with and without complications. No association between complications and baseline patient demographics was found.

CONCLUSION

This study demonstrated high safety and efficacy of the TVT operation with only minor short-term complications and few long-term re-operations. The ICIQ-UI SF improved significantly postoperatively and was not statistically significantly affected by the occurrence of complications.

Comparison of retropubic midurethral slings in the treatment of female stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

Over 50 different types of midurethral slings have been marketed. They have generally been considered comparable in performance. Many studies have compared retropubic with obturator slings, but few have compared different makes of retropubic slings with each other. We have compared the performance of retropubic slings using data from the Norwegian Female Incontinence Registry.

METHODS

From June 2015 through 2017, 2843 women underwent a retropubic sling procedure, with 6-12-month follow-up data available for 2612 (92%). Results for six different types of slings used in this time period are presented: TVT Exact, TVT Classic, Advantage, Advantage Fit, TVT A.M.I. and RetroArc. The TVT Exact was the most prevalent sling, and the outcomes were compared with this sling as reference using chi-square and Dunnet's tests with significance at 0.05.

RESULTS

There were only small differences among the four slings, TVT Exact, TVT Classic, Advantage and Advantage Fit, with subjective cure rates from 77.7 to 81.9% and objective cure rates from 90.8 to 96.6%. The TVT A.M.I. sling had a high cure rate but significantly fewer satisfied patients and less improvement in urgency bother. The Retro Arc's results were clearly inferior. There was little difference in terms of obstruction or de novo urgency incontinence among the six slings. Most complication rates were not statistically different.

CONCLUSIONS

At 6-12-month follow-up there was no significant difference in clinical results between the TVT Exact, TVT Classic, Advantage and Advantage Fit slings, while RetroArc and to some extent TVT A.M.I. slings underperformed.

The Efficiency and Safety of Tension-Free Vaginal Tape (TVT) Abbrevo Procedure Versus TVT Exact in the Normal Weight and Overweight Patients Affected by Stress Urinary Incontinence

OBJECTIVE

To compare the efficacy between 2 different slings in normal weight and overweight women.

METHODS

Of 426 women, 220 (119 normal weight and 101 overweight) accepted the tension-free vaginal tape Abbrevo (TVT-A) and 206 (114 normal weight and 92 overweight) accepted the TVT Exact (TVT-E) procedure. Data collected contained the subjective efficiency, objective efficiency International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Incontinence Quality of Life Questionnaire (I-QOL), Pelvic Floor Impact Questionnaire-Short Form (PFIQ-7), Urogenital Distress Inventory-Short Form (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form (PISQ)-12 at 36 months after surgery.

RESULTS

In the normal weight patients, the subjectively and objectively cured rates were all high in both TVT-A and TVE-E (94.12% and 95.61% in objective result; 92.44% and 94.74% in subjective result). In addition, the score of I-QOL, PFIQ-7, and UDI-6 have significantly changed (P <.00001 in each one). In the overweight patients, the subjective and objective efficiency were better in TVT-E than TVT-A. Moreover, the score of I-QOL, PFIQ-7, and UDI-6 of overweight women have significantly changed only in the TVT-E (P <.00001 in each one), whereas both procedures have no effect on the score of PISQ-12 (P = .063 and P = .180 for TVT-A and TVT-E, respectively).

CONCLUSION

The TVT-E might be a better choice for the overweight patient than TVT-A.