Beyond the Abstract - Efficacy and safety of the TVT-SECUR® and impact on quality of life in women with stress urinary incontinence: A 2-year follow-up, by Myung Ki Kim

BERKELEY, CA (UroToday.com) - Stress urinary incontinence (SUI) adversely affects the quality of life and well-being of approximately 15% of the female population.

The treatment options for SUI include retropubic suspensions and slings, transobturator tape procedures, injectable bulking agents, and less commonly, artificial urinary sphincter placement. The retropubic tape has been effective for many years but exposes patients to serious complications, such as bladder perforations, principally because of the use of the retropubic space for the fixation of the tape. In an attempt to avoid the retropubic space, the second generation of sling, the transobturator tape, was introduced in 2001. In contrast to transgressing the retropubic space, the TOT procedure passes trocars blindly through the obturator foramen in an “inside-out” or “outside-in” fashion that thus obviates the risk of injury to the retropubic organs. Although promising, the TOT has been associated with a small but defined risk of prolonged leg pain, ostensibly owing to passage of the transvaginal mesh through the obturator foramen proper. The recent generation of midurethral slings, the tension-free vaginal tape SECURⓇ (TVT-S, Gynecare, Ethicon, Somerville, NJ, USA), introduced in 2005, attempts to lower the number of complications by involving only a small vaginal incision and utilizing a shorter sling (8 cm) that is anchored directly to the retropubic fascia (U method) or the obturator internus muscle (H method). These steps lead to less dissection, lower amounts of synthetic material, and possibly fewer complications. Exit points are unnecessary, which reduces the immediate and persistent pain.

Only a small number of articles on the use of TVT-S are available in the published data. Reported success rates for the TVT-S are of about 80%. To our knowledge, the first report came from Martan, et al. in January 2007. At 1-3 months of follow-up, they reported a cure rate of 93% in 15 patients, 10 with the Hammock technique. In 2008, Debodinance, et al. published an article on 110 patients with a dry rate of 70.4% at 2 months. This report actually reveals a low cure rate compared with conventional midurethral slings, but the technique used was the Hammock technique in 85.5%. More recently, Oliveira, et al. reported, in January of 2009, good success rates in 107 patients with a mean follow-up of 15 months. Eighty-five percent of the patients were either dry or improved. In our study, we use the U method and the overall cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S.

As the questionnaire is a subjective measure, it should be convenient and easily understood. The I-QoL is easily self-administered and takes approximately 5 minutes for the average patient reading at a fifth-grade level to complete. It is available in 16 different language versions and has been validated in four European countries as well as the United States. Also, we used a Korean version of I-QoL. The I-QoL questionnaire is a targeted condition-specific questionnaire that assesses the effect and distress of specific symptoms of SUI. The potential advantage of the I-QoL over previous measures is its applicability to patients over a range of ages and with varying types and severities of SUI.

In our study, based on outcome of I-QoL, patients experienced a significant improvement in their quality of life with this procedure.

 

Written by:
Myung Ki Kim as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

 

Efficacy and safety of the TVT-SECUR® and impact on quality of life in women with stress urinary incontinence: A 2-year follow-up - Abstract

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