[TVT: three years of experience]

Quality of life in women with urinary stress incontinence and evaluation of tension-free vaginal tape treatment

OBJECTIVES

Assessment of quality of life in women stress urinary incontinence (USI) and evaluation of tension-free vaginal tape (TVT) treatment.

MATERIAL AND METHODS

The research included a group of 112 women aged 33-78 years. Before as well as 3 and 6 months after the TVT operation, patients were asked to fill in quality of life questionnaires.

RESULTS

After 3 months 87.25% of the women reported full regression of USI symptoms, 7.8% an insignificant improvement, and 4.9% did not observe any change. After 6 months 85.71% reported full regression, 9.18% an insignificant improvement, and 5.1% did not observe any change. USI is responsible for a decrease in physical activity. The most uncomfortable symptom is involuntary urine leakage occurring mainly during an effort or sleep. After the TVT procedure, the majority of women confirmed a significant improvement in quality of life.

CONCLUSIONS

The TVT procedure is an effective method of treating USI in women: it significantly improves quality of life, with a recovery rate of 85-87%, and a low rate of complications.

[TVA and TOA. New adjustable mesh for the treatment of female stress incontinence. Preliminaries results]

OBJECTIVES

Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during surgery to be readjusted at the post-operative stage.

PATIENTS AND METHOD

62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of bladder full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I).

RESULTS

42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow < 10 ml/sec and/or residue). The tension of the mesh was tightened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable improvement in their incontinence. The Q(MAX) is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn't (15%). The clinical report showed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life.

CONCLUSION

With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during surgery at the post-operative stage, so that any defects or excesses can be corrected.

[Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases]

INTRODUCTION

The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity. good clinical results and rare complications.

MATERIAL AND METHODS

From april, 1999 to march. 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10.36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56.6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1% of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomy.

RESULTS

We obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient: 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization: one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy: one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures: and one patient presented pelvic discomfort with spontaneous resolution.

CONCLUSIONS

We consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications.