TVT tape adjustment technique as a factor in reducing postoperative voiding disability and improving the success rate
IUGA Academy. El Halwagy H. Jun 30, 2018; 212838; 421 Topic: Dysfunctional Voiding
Mr. Hosam El Halwagy
Mr. Hosam El Halwagy

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421

TVT tape adjustment technique as a factor in reducing postoperative voiding disability and improving the success rate

Elhalwagy, H1; O'kane, M1; kumusidis, A1

1: east sussex NHS healthcare trust

Introduction: TVT midurethral sling is the most commonly performed procedure for stress incontinence as extensive research has confirmed its efficacy and acceptable risk (1). It has been estimated that voiding difficulty can occur in up to 20% following TVT insertion; and 1-10% may continue to use the catheter more than 28 days (2).

Objective: We postulate that the ‘633’ tape adjustment technique is associated with a better success rate and less postoperative voiding difficulty.

Methods: This is a retrospective analysis of 91 patients who underwent TVT midurethral slings for treatment of stress incontinence using ‘633’ technique. This involves measurement of the urethral length Foley’s catheter and with marking of the urethral orifice. The Tape is inserted using the usual technique. A size 6 Hagar is inserted into the urethra, while a two size 3 Hegar are placed below the urethra and Tape is adjusted over them at the midurethra. Urethral length is re-measured at the end of the procedure.

Results: A hundred women have been chosen and only 91 was followed up to one year. Mean age is 54.7 years and mean BMI 29.5. At one year, the overall success rate was 90 % with an improvement of ICIQ QOL score of -37.6. Three women (3%) have developed dyspareunia and one (1%) had groin pain that necessitate removal of the tape within few days. None of the patients had Tape erosion. The rate of voiding difficulty (VD) was 3%. As a secondary outcome measure, we found that the mean increase in the urethral length of 0.55 cm in successful cases. However on using ROC curve, we found no significant association between a successful outcome of TVT and certain threshold value for the increased urethral length (Area under the curve is 0.52).

Conclusion: Our study showed that tape adjustment technique may contribute to an improvement in overall success rate of midurethral slings and reduction of postoperative VD. An increase in the urethral length can be an important factor that contributes to the high success rate. The study has its limitation of being uncontrolled, but it raises an important question about the effect of the insertion technique in improving the outcome measures.

References:

1 Updated systematic review and meta-analysis on comparative data of colposuspension,pubovaginal sling and midurethral sling in the surgical treatment of female stress incontinence. EUR Urol 2017;72:567-91.

2 Post sling urinary retention in women. Current Urol Rep. 2016; 17:83.

Disclosure:

Work supported by industry: no.

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