TVT-O For Female Stress Urinary Incontinence Evaluated By Urodynamic Study

ObjectiveTo follow up the female stress urinary incontinence (SUI) patients treated with Transobturator Vaginal Tape Inside-out (TVT-O) procedure by using urodyanmic studies.Patients and methodsPatientsFrom January 2008 to February 2009, fifty women (aged (55.1±7.53) years old) with SUI who underwent TVT-O were included. All patients showed no detrusor overactivity, bladder atony, residual urine volume≥100ml, neurogenic bladder, acute urinary tract infection and acute vaginal infections. Before treatment and after sugery procedures, the score of International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-sF) and urodynamics evaluation were recorded. The parameters were compared.Urodynamic StudyA conventional urodynamic testing was carried out in all women, including uroflowmetry, cystometries, and urethral pressure profile by using the Duet Logic urodynamic unit (Medtronic Corporation, Denmark). Filling cystometry and urethral pressure profile were performed with 37℃0.9% normal saline with an infusion rate of 50 mL/min in. A microtransducer catheter at a withdrawal rate of 1 mm/s was used for the urethral pressure profile. The Maximal flow rates(Qmax), and Post-void residual(PVR) were recorded in uroflowmetry. The First desire(FD), Maximum detrusor pressure(Pdet. max), Bladder compliance(BC), Maximum cystometric capacity(MCC),, were also recorded in the filling cystometry. The maximal urethral pressure(MUP), maximal urethral closure pressure(MUCP) and functional urethral length (SFL) were included in the urethral pressure profile. The methods and definitions conform to the standards proposed by the International Children's Continence SocietyClinical observation and follow-upThe average follow-up is 12.6 months. During the follow up the ICS-Q-SF and urodynamic study were carried out. The Efficacy parameters include ICS-Q-SF, Qmax, PVR, FD, MCC, BC, Pdet. max, MUP, MUCP, SFL.A criteria of treatment response is defined as follows:Cure: After the surgery the patients with no urine leakage and no longer in use changing mat.Improve:Patients taking physical activity with a small amount of urine leakage, but satisfied with the result.Invalid:Patients with severe leakage of urine which influence the quality of life.Statistical analysisAll data values are expressed as the mean±deviation (SD). The mean values were statistically compared using the Student's t-test for two paired groups with the use of software SPSS 13.0. Significant statistical difference was considered at P 0.05ResultsThirty-three women were successfully followed in our study. ICI-Q-sF and maximum flow rate were significantly lower than those before treatment(0.2±0.1 vs 14.6±3.2; 26.4±5.5ml/s vs 30.6±8.1ml/s;P<0.05); In contrast, no statistical differences in PVR, Pdet.max, FD MCC, BC, MUP, MUCP and SFL before operation and during follow-up (P>0.05). Intraoperative injury such as bladder injury; urethra injury, obturator nerve injury, intestinal perforation, hematoma were not found; Complications included one (2.4%) voiding difficulty, two (6%) groin pain and one (3%)de novo urge urinary incontinence, which were improved after symptomatic treatment. The overall cure rate was 85%(28 of 33 patients) and 12%(4 of 33 patients) had improvement of symptoms.ConclusionThe TVT-O procedure is an efficient treatment for female SUI, and urodynamic study is good tool to follow up the patients.