The Solution of Stress Urinary Incontinence in Women by the TVT-S Surgical Method – Correlation between the Curative Effect of this Method and Changes in Ultrasound Findings
Authors:
A. Martan 1; K. Švabík 1; J. Mašata 1; T. Koleška 1; Rachid El-Haddad 1; M. Pavlikova 2
Authors‘ workplace:
Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
1; EuroMISE Centrum, Ústav informatiky Akademie věd České republiky v. v. i., prof. RNDr. J. Zvárová, DrSc.
2
Published in:
Ceska Gynekol 2008; 73(5): 271-277
Category:
Original Article
Overview
Objective:
The aims of this study were to compare ultrasonographic findings of the urethra and the tape position and mobility following the tension-free vaginal tape secure system (TVT-S) procedure and to correlate these data with clinical signs of cure and failure of this procedure in the treatment of stress urinary incontinence (SUI) in women. Another aim of our study was to determine indications for particular position of the tape (the “hammock” or “U” position) based on ultrasonographic findings of the urethra and the tape position following TVT-S.
Design:
Prospective, randomized study.
Settings:
Department of Gynecology and Obstetrics, First faculty of Medicine, Charles University and General Teaching Hospital, Prague.
Materials and methods:
Analyses of the position of the urethra and the tape of 85 patients were performed using perineal ultrasonography. The efficacy of the TVT-S procedure was evaluated by cough test and by the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-UI SF).
Results:
Objective assessment by cough test showed that 53 (62%) of our patients were completely dry, and in 32 (38%) patients leakage of urine persisted after the operation. From the US examination and results we can conclude that 3 months after the operation the mobility of the urethra and bladder neck are restricted. A correlation between cure effect and the restriction of the movement of the urethra was found between the position at the middle of the urethra before and after the operation. Subjective assessment of the cure effect of this operation by the ICIQ-UI SF questionnaires (n=81) showed that 39 (48%) of our patients were completely dry and 24 (30%) of patients improved, which means that in 42 (52%) patients leakage of urine persists after the operation. There are differences in the restriction of urethral mobility between the cured patients and those where leakage persisted. The middle of the urethra and UVJ are more restricted in movement in cured patients. We found no statistically significant differences between the US measurements of the position of the urethra of patients with the tape in the “hammock” and the “U” position. The only statistically significant difference found is a slightly higher tension of the “U” tape three months after the operation during the Valsalva maneuver; the median width of the tape in the “hammock” position is 10.1 mm, while in the “U” position it is 8.1 (Wilcoxon test p = 0.0056). There were six patients diagnosed with urgency de novo, without urge incontinence in this series. In seven cases we found vaginal erosion.
Conclusions:
From the US examination and results we can conclude that after the TVT-S operation, mobility of the urethra and bladder neck is restricted. After comparing ultrasonographic findings of the urethra and the tape position following TVT- Secure we can determine that there is no certain indication for placement of the tape in the „hammock“ or the „U“ position. The cure effect for different positions of the tape is similar. In some respects the slightly higher tension of the tape in the „U“ position suggests that this tape position may be preferred in patients with intrinsic sphincter defect (ISD) of the urethra. A comparison of the cure effect of the TVT-S procedure with other tape procedures suggests a lower cure effect of this operation.
Key words:
stress urinary incontinence, complications, TVT-S system, transperineal ultrasound.
Sources
1. Avery, K., Donovan, J., Abrams, P. Validation of a new questionnaire for incontinence: the international consultation on incontinence questionnaire (ICI-Q). Neurourol Urodyn, 2001, 20, p. 86.
2. Boyles, SH., Edwards, R., Gregory, W., et al. Complications associated with transobturator sling procedures. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18, p. 19-22.
3. Bump, RC., Brubaker, BK., Delancey, L. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 1996, 175, p. 10-17.
4. Delorme, E. Trans-obturator urethral suspension: miniinvasive procedure in the treatment of stress urinary incontinence in women. Prog Urol, 2001, 11, 6, p. 1306-1313.
5. DeLeval, J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol, 2003, 44, p. 724-730.
6. Dietz, HP., Wilson, PD. The “iris effect”: how two-dimensional and three-dimensional ultrasound can help us understand anti-incontinence procedures. Ultrasound Obstet Gynecol, 2004, 23, p. 267-271.
7. Dietz, HP., Barry, C., Lim, YN., Rane, A. Two-dimensional and three-dimensional ultrasound imaging of suburethral slings. Ultrasound Obstet Gynecol, 2005, 26, p.175-179.
8. Chene, G., Cotte, B., Tardicu, AS., et al. Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT, TVT and TVT-O). Int Urogynecol. J Pelvic Floor Dysfunct, 2008, 19, p. 1125-1131.
9. Lose, G., Grifiths, DJ., Hosker, G., et al. Standardisation of urethral pressure measurement: Report of the sub-committee of the International Continence Society. Neurourol Urodyn, 2002, 21, p. 258-260.
10. Masata, J., Martan, A., Klasikova, E., et al. Ultrasound study of the effect of TVT operation on the mobility of the whole urethra. Neurourol Urodyn, 2002, 21, p. 286-288.
11. Ng, CCM., Lee, LC., Han, WHC. Use of three-dimensional ultrasound scan to assess the clinical importance of midurethral placement of the tension-free vaginal tape (TVT) for treatment of incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 2005, 16, p. 220-225.
12. Novara, G., Galfano, A., Boscolo-Berto, R., et al. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: A systematic review and meta-analysis of randomized controlled trials comparing Tension – Free Midurethral tapes to Other Surgical Procedures and Different Devices. Eur Urol, 2008, 53, p. 288-308.
13. Rezapour, M., Novara, G., Meier, PA., et al. A 3-month preclinical trial to assess the performance of a new TVT-like mesh (TVTx) in a sheep model. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18, p. 173-182.
14. Salvatore, S., Serati, M., Uccella, S., et al. Inter-observer reliability of three different methods of measuring urethrovesical mobility. In press: Int Urogynecol J Pelvic Floor Dysfunct, 2008, DOI 10.1007/s00192-008-0671-2.
15. Schaefer, W., Abrams, P., Liao, L., et al. Good Urodynamic Practices: Uroflowmetry, Filling Cystometry, and Pressure-Flow Studies. Neurourol Urodyn, 2002, 21, p. 261-274.
16. Ulmsten, U., Petros, P. Intravaginal slingplasty (IVS): an ambulatory procedure for treatment of female urinary incontinence. Scand J Urol Nephrol, 1995, 29, p. 75-82.
17. Yang, JM, Huang, WC. Sonographic findings in a case of voiding dysfunction secondary to the tension-free vaginal tape(TVT) procedure. Ultrasound Obstet Gyneco., 2004, 23, p. 302-304.
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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
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