Clinical Analysis Of Tension-free Vaginal Tape Obturator Technique Procedure In The Treatment Of Female Stress Urinary Incontinence

Background and PurposeMinimally invasive suburethral sling procedures have become a mainstay for the surgical treatment of women affected by stress urinary incontinence(SUI).The tension free vaginal tape(TVT) procedure,introduced by Ulmsten and collaborators in 1996,is currently considered to be the gold standard surgery for female SUI.This surgical technique is associated with high cure rates after long term follow-up.Though it is efficacy of the TVT procedure,intra- and postoperative complications resulting from the penetration of the surgical device into pelvic organs(bladder,urethra and bowel), nerves,and vessels,have been reported.In 2001,so as to spare the pelvic space, proposed an outside-in transobturator approach(TOT) for the placement of a suburethral tape has been proposed.Initial clinical data and anatomic studies have suggested that,as compared with retropubic techniques,the outside-in TOT may be associated with reduced complication rates.Yet,results from lots of clinical studies have shown that bladder and urethra injuries can occur with the outside-in technique.Rapidly,De Leval have developed the inside-out transobturator vaginal tape(TVT-O) procedure for the treatment of female SUI in 2003,with the aim of minimizing the risk of lower urinary tract(LUT) injury,maximizing the reproducibility of the tape's insertion,and ensuring minimal tissue dissection.Anatomically,the TVT-O tape does not enter the pelvis. Consequently,as opposed to retropubic sling systems,it is suggested that no intraoperative cystoscopy is required when performing the TVT-O procedure.We present our clinical data to evaluate the treatment efficacy and safety of tension free vaginal tape obturator technique(TVT-O) in females with stress urinary incontinence (SUI).Materials and Methods1.Including and excluding standard(1)The included standardsCollecting the cases according to the definition of stress urinary incontinence (the patients involuntary loss of urine during physical activity,the statement occurring when,in the absence of detrusor contraction,the intravesical pressure exceeds the maximum urethral pressure.).SUI can be divided three degrees according the severity of the clinic symptoms:Mild:the urinary incontinence only occurred when abdominal pressure rise rapidly,during the intense activity such as running or cough.The urinary incontinence did not occur during the daily activity.Midrange:the urinary incontinence occurred during the daily activity such as walking or standing up. Severity:the urinary incontinence occurred when changing the decumbent position or even resting.(2) The excluded standardsExclusion criteria included the urge urinary incontinence(UUI) patients who have overactive bladder(OAB) according the urodynamic evaluation;the mixed urinary incontinence(MUI) patients,which present with both urge urinary incontinence symptoms,overactive bladder and stress urinary incontinence symptoms; and the neurological bladder patients. 2.Case collection76 female patients with stress urinary incontinence(SUI) had been assigned to undergo TVT-O surgery from November 2003 to June 2008 in our hospital and followed up 3～12 months.The data had been collected and analyzed yet respectively.A detailed record of the name,gender,age,home address,telephone number,weight index,preoperative symptom degree of the urinary incontinence,preoperative ICI-Q-SF score,preoperative peak flow rate(Q_max),abdominal leak point pressure(ALPP),posvoid residual(PVR) the merger disease,operative times,amount of bleeding,postoperative complications(bladder perforation,vascular injury,bleeding, haematoma,fever,pain,tape erosion and voiding difficulty),days of postoperative urinary drainage tube stet,the hospitalization time after operative,the postoperative ICI-Q-SF score,the follow up information and other items.ResultsThe age of the 76 patients arranged from 40 to 75 years,the mean value was 52.4±9.63 years.Mean body mass index was 24.2±2.23kg/m².All patients were multipara.27 cases(35.5%) had one parity,34 cases(44.7%) two,11cases(14.5%) three,3 cases(4.0%) four,and 1 cases(1.3%) five.Course of disease was 1～30 years, the mean value was 9.3±3.80 years.Preoperative symptom degree:Mild:17 cases (22.4%),Midrange:54 cases(71.1%),Severity:5 cases(6.5%).Preoperative ICI-Q-SF score was 7～19,the mean value was 13.5±2.94.Mean preoperative peak flow rate was 24.0±10.98ml/s.Typeâ… (ALPP≥90cmH₂O) 21cases(27.6%),typeâ…¡(ALPP60～90cm H₂O) 40cases(52.7%),typeâ…¢(ALPP≤60cmH₂O) 15 cases(19.7%).Post-void residual was 0～20ml.2 cases(2.63%) merged cystitis glandularis,3 cases(3.95%) merged the bulging of paries anterior vaginase,4 cases(5.26%) merged the raise of vesical neck,3 cases(3.95%) merged uterine prolapse(Ⅰ°),4 cases(5.26%) merged the degrade of bladder complaisance,1 cases(1.32%) merged bladder tumor,2 cases(2.63%) recidivated after TVT.Surgery operative times was 15～38 min,the mean value was 20.1±5.3min.Amount of bleeding was 10～70ml,the mean value was 20.6±10.7ml.The urinary drainage tube had been removed 2～6 days after the operation.The patients discharged 2～8 days after the operation.Patients had been followed up 3～12 months, the contents were the subjective and the complain include the information of the symptoms improvement and the postoperative complications.The incontinence symptoms disappeared in all patients after the operation,the postoperative ICI-Q-SF score was 0～2,the mean value was 0.45±0.526.There was significant difference regarding preoperative ICI-Q-SF score(P＜0.01).Two cases(2.63%) generated postoperative voiding difficulties,one of them improved after applied heat on hypogastric zone,one of them set the urinary drainage tube again and removed after 5 days,voiding normally.One old patient(1.32%) generated postoperative urinary retention,symptom improved after dilating urethra two times.One patient(1.32%) complained of pain in the bilateral thighs and hips.This symptom abated after five days. There were no patient with urethra and bladder injury,vaginal wall laceration,heavy bleeding,infectious complications,vaginal or urethral erosion,vesico-vaginal fistula after the operation in our group.Conclusion:TVT-O procedure is simple,effective and safe procedure with lower complication rate and less risk of injury.It is a satisfactory technique for the surgical treatment of the female urinary stress incontinence.