Urethral complications after tension-free vaginal tape procedures:A surgical management case series

AIM： To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS： This study encompasses a retrospective review of nine patients presented with urethral complic-ations after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset （〈 12 mo） or late onset （〉 12 mo） according to when they were frst reported.RESulTS： Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence （7/9 patients）, urinary retention/voiding dysfunction （4/9 patients）, urethritis （4/9 patients）, relapse of stress-incontinence （3/9 patients）, recurrent urinary tract infections （5/9 patients）, and hematuria （1/9 patient）. In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. COnCluSIOn： Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.

POSTOPERATIVE EVALUATION OF TENSION-FREE VAGINAL TAPE PROCEDURE

Objective To study the outcome of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with cystocele. Methods Forty-two patients with SUI confirmed by urodynamics underwent the TVT procedure under local anesthesia. A prolapse repair was done simultaneously. Results Mean TVT operation time was 26.29 minutes. Mean blood loss was 29.86 mL. Eighty-eight percent of the patients were able to micturate spontaneously within 12 hours and residual urine was less than 100 mL. And 12% of the patients had to use indwelling catheter for 3-11 days. Average hospital stay was 2.91 days. Eighty-eight percent of patients were discharged within 2 days. All patients were followed up (an average of 10.26 months). According to subjective and objective assessment of the outcome, 39 patients (93%) were cured, another 3 patients (7%) were significantly improved and none was failed. There were no major complications such as bladder injury occurred. Conclusion TVT procedure is a minimal invasive, effective, and safe surgery for treatment of SUI.

Inside out transobturator vaginal tape versus tention-free vaginal tape for primary female stress urinary incontinence： meta-analysis of randomized controlled trials

Background Inside out transobturator vaginal tape （TVT-O） and tension-free vaginal tape （TVT） are predominant surgical treatments for female stress urinary incontinence. This meta-analysis evaluated the complications and cure rates of TVT-O versus TVT. Methods A comprehensive literature search was conducted according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials with no language restriction. Two authors independently assessed papers for eligibility and methodological quality. Estimates were measured by relative risk with 95% confidence intervals. Outcome measures were objective cure, subjective cure and complications. Quality rating for each outcome of the meta-analysis and recommendations were performed by the Grading of Recommendations Assessment, Development, and Evaluation （GRADE） system. Results Twenty randomized controlled trials met the inclusion criteria, and a pooled estimate of effectiveness and complications was made. Relative risks with 95% confidence intervals for pooled effects under the fixed effects model were： 0.20 （0.09-0.45）, for bladder injury, 0.37 （0.16-0.86） for hematoma, and 2.35 （1.57-3.51） for postoperative pain, suggesting an 80% risk reduction of bladder injury, 63% risk reduction of hematoma, and a 1.35% risk elevation for postoperative pain with TVT-O. There was no significant difference between complications of urinary tract infection 1.14 （0.78-1.65）, lower urinary tract symptoms 1.60 （0.67-3.79）, recatheterization 0.93 （0.59-1.44）, and tape erosion 0.90 （0.48-1.67）, total objective cure rate 1.06 （0.39-2.84） and for the subjective cure rate 0.98 （0.93-1.04）. The quality rating for each outcome and recommendations was high for objective cure, bladder injury, hematoma, lower urinary tract symptoms, and tape erosion and moderate for subjective cure, pain, and urinary tract infection. Conclusions TVT-O is associated with a reduced risk of bladder injury and hematoma and an elevated risk of postoperative pain. Other complications, including tape erosion,urinary tract infection, lower urinary tract symptoms, and recatheterization, are similar to those of TVT.

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁的疗效

目的:探讨经闭孔无张力尿道中段悬吊术(Transobturator tension-free vaginal tape surgery,TVT-O)治疗女性压力性尿失禁(Stress urinary incontinence,SUI)的疗效及安全性。方法:回顾性分析2005年1月-2006年6月接受TVT-O的36例女性SUI患者的临床资料,随访时间1-18个月,其中I型I、I型SUI 32例(88.9%),I型或II型SUI伴内括约肌功能缺陷(ISD)4例(11.1%)。TVT-O的麻醉均采用腰麻。结果:36例女性SUI患者尿垫试验术前为20.6±3.7 g,术后为7.6±2.2 g,两者比较差异有统计学意义(P<0.01);尿失禁症状评分术前为18.2±1.7分,术后为1.2±2.1分,两者比较差异有统计学意义(P<0.01)。术后达到完全控尿者28例(77.8%),有效控尿者8例(22.2%),未出现无效患者。术中无明显并发症,术后并发症主要表现为大腿内侧不适、尿频、尿急及排尿不适,未出现尿潴留、膀胱破裂、阴道壁或尿道糜烂等严重并发症。结论:TVT-O是目前治疗女性SUI的一种有效、安全的微创手术。

压力性尿失禁诊疗135例临床分析(英文)

Objective The purpose of this study is to evaluate and compare the two different treatments by researching 135 cases with stress urinary incontinence.Methods From June 2006 to June 2010,135 patients with stress urinary incontinence were treated in Department of Gynecology and Obstetrics of Peking University Shenzhen Hospital.91 cases of them were treated with low frequency electric stimulation and biofeedback therapy (Group A),and the other 44 cases were treated by improved transobturaor tension-free vaginal tape(TVT-O) and TVT-O (Group B).Then,we compared these two groups by whole recovery rate,recovery rate of patients with urge incontinence,charge of treatment and complication,respectively.Results Group B's recovery rate for stress urinary incontinence was 100%.Ⅰ degree stress urinary incontinence in Group A's recovery rate was higher;Ⅱ degree patients' recovery rate for stress urinary incontinence was lower;Ⅲ degree patients' recovery rate was 0%.Only 1 case showed abnormal urine stream;2 cases showed urinary retention,but the symptoms disappeared after the treatment.No significant complication in Group A.There were huge differences of the expense between the two groups.The effect in Group A for patients with urge incontinence was good,but there was no effect shown in Group B.Conclusions The two treatments are safe and effective for stress urinary incontinence,but there are existed prominent differences of the therapeutic efficacy between the two groups.