Aims
of
the
study :
Tension free vaginal tape (TVT) is a relatively
new
technique
of
stress
urinary
incontinence
cure.
Some
medium
term
follow-up
results
are
available
(1,2,3).
To
our
knowledge,
there
are
no
data
about
results
of
TVT
associated
with
prolapse
cure,
because
these
cases
were
excluded
from
scandinavian
studies.
The
aims
of
the
study
was
to
compare
per
and
post
operative
complications
and
results
of
TVT
whether
isolated
(in
case
of
stress
or
mixed
incontinence
without
significant
prolapse)
or
associated
with
pelvic
organ
prolapse
cure.
Methods :
A continuous series of 187 patients was operated on with TVT under spinal
anesthesia
during
1997
and
1998.
One
hundred
and
seventy
one
were
available
for
one
to
three
years
of
follow-up.
A
strict
pre
operative
protocol
including
history,
clinical
examination,
urodynamic
evaluation,
perineal
ultrasound,
one
hour
pad
test
and
quality
of
life
questionnaire
was
performed
and
repeated
each
next
year
of
follow-up.
Results :
Pre and post operative complications are very similar (Table I) but prolapse
cure
induce
micturition
difficulties
:
28
patients
(32
%)
versus
5
(5,8
%)
needed
post
operative
clean
self-catheterisations.
Results
are
summarized
in
Table
II
:
stress
urinary
incontinence
is
cured
in
about
90
%
of
each
group,
urge
incontinence
in
case
of
mixed
incontinence
was
cured
in
about
60
%
of
each
group
(with
2
cases
in
each
group
of
"de
novo"
overactive
bladder)
frequency-urgency
syndrom
was
cured
in
65
%
of
isolated
TVT
and
in
54
%
of
associated
TVT
patients.
The
comparison
of
voiding
disorders
is
more
difficult
:
the
prolapse
correction
cured
60
%
of
pre
operative
micturition
difficulties,
but
associated
TVT
induced
3
"de
novo"
voiding
disorders
among
46 prolapse
(6,5 %),
while
isolated
TVT
induce
4
"de
novo"
voiding
disorders
among
77
without
prolapse
patients
(5,2 %).
|
|
Isolated T.V.T.
n
=
85
|
Associated T.V.T.
n
=
86
|
Global
results
n
=
171
|
Bladder
injury
|
7
|
6
|
13
(7,6
%)
|
|
Bleeding
>
300
ml
|
3
|
1
|
4
(2,3
%)
|
|
Hematoma
|
1
|
4
|
5
(3,8
%)
|
|
Urinary
tract
infections
|
6
|
6
|
12
(7,0
%)
|
|
Pain
|
2
|
2
|
4
(2,3
%)
|
|
Intolerance
|
0
|
0
|
0
|
|
Catheteris.
Number*
|
2
(0-10)
|
6
(0-26)
|
8
(0-26)
|
|
Self
catheteris
duration
<
7
d
|
4
|
12
|
16
(9,3
%)
|
|
7-14
d
|
0
|
8
|
8
(4,6
%)
|
|
>
14
d
|
1
|
8
|
9
(5,2
%)
|
*
number
of
catheterisations
before
2
residuals
<
100
ml,
beginning
on
Day
+
1
if
isolated
and
Day
+
2
if
associated
Table
I
-Per
and
post
operative
complications
of
patients
operated
on
during
1997
and
1998 :
171
patients
controlled
|
|
Isolated T.V.T.
|
Associated T.V.T.
|
Global results
|
|
Stress
incontinence
|
n
=
85
|
(%)
|
n
=
71
|
(%)
|
n
=
156
|
(%)
|
|
- cured
|
75
|
(88,2)
|
64
|
(90,1)
|
139
|
(89,1)
|
|
- improved
|
10
|
(11,8)
|
5
|
(7,0)
|
15
|
(9,6)
|
|
- identical
|
0
|
|
2
|
(2,8)
|
2
|
(1,3)
|
|
- worse
|
0
|
|
0
|
|
0
|
|
|
- de
novo
|
0
|
|
0
|
|
0
|
|
|
Mixed
incontinence
|
n
=
31
|
%
|
n
=
38
|
%
|
n
=
69
|
%
|
|
- cured
|
19
|
(61,3)
|
22
|
(57,9)
|
41
|
(59,4)
|
|
- improved
|
2
|
(6,4)
|
4
|
(10,5)
|
6
|
