Bladder injury and success rates following retropubic mid-urethral sling: TVT EXACT™ vs. TVT™.

Although placement of a retropubic mid-urethral slings (MUS) is one of the gold standard surgical treatments for stress urinary incontinence, new devices are poorly evaluated before marketing. We compared TVT-EXACT™ (TVT-E), a new device expected to reduce bladder injuries, with the historically described bottom-to-top TVT™ (TVT).

This retrospective study compared TVT-E (n=49) and TVT (n=49). The main outcomes were the prevalence of complications (bladder injuries, immediate postoperative pain, perioperative complications, etc. ) and the short-term success rate (no reported urinary leakage and negative cough test) of both MUSs.

Minimum follow-up was 12 months. The characteristics of the two groups were comparable. The prevalence of bladder injury for TVT-E and TVT was 8% and 6%, respectively (p=1). The intensity of immediate postoperative pain (VAS/100) was lower following TVT-E than after TVT (8. 0 vs. 15. 9, p=0. 01). The first post-void residual was increased in the TVT-E group (153. 9 vs. 78. 9mL, p=0. 045), and there were more postoperative bladder outlet obstruction (BOO) symptoms in the TVT-E group (24% vs. 6%, p=0. 02). However, there was no difference when considering only de novo BOO (14% vs. 4%, p=0. 16). The prevalence of peri- and post-operative complications was equal in the two groups. The success rate was similar at 12 months of follow-up (80 vs. 82%, p=1).

The prevalence of bladder injury was unchanged with TVT-EXACT™ compared with TVT™, but post-operative pain was decreased. The success rate of both retropubic MUSs was similar at 12 months of follow-up.

European journal of obstetrics, gynecology, and reproductive biology. 2016 Jan 11 [Epub ahead of print]

Thibault Thubert, Virginie Canel, Marie Vinchant, Ingrid Wigniolle, Hervé Fernandez, Xavier Deffieux

APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France. , APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France. , APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France. , APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France. , APHP, Hôpitaux Universitaires Paris Sud, Hôpital Bicêtre, Service de Gynécologie Obstétrique, Le Kremlin Bicetre F-94275, France. , APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France.  

PubMed

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