Neuman Menahem
Urogynecologic Service, Department of Gynecology, Shaare-Zedek Medical Center, Jerusalem, Israel.
Eur Urol. 2007 Apr;51(4):1083-7; discussion 1088. doi: 10.1016/j.eururo.2006.10.003. Epub 2006 Oct 18.
To evaluate the short-term therapeutic results of a novel minimally invasive anti-incontinence operative procedure-the tension-free vaginal tape (TVT)-obturator.
With this prospective, observational, and consecutive patient series, TVT-obturator surgery was performed, according to de Leval (2003), by the same surgeon on 300 patients with urodynamically proven stress urinary incontinence. Follow-up lasted 4-24 mo.
The demographic and therapeutic aspects of the patient group data were evaluated. The TVT-obturator required neither bladder catheterization nor intraoperative diagnostic cystoscopy. Half of the 18 (6%) patients with postoperative voiding difficulties had postoperative urethral bladder catheterization for 1-4 d, whereas the other 9 patients underwent a tape loosening procedure in theater under anesthesia. The early therapeutic failure rate for the TVT-obturator procedure was 2.7% (8 patients). Six of the latter patients underwent an interval TVT operation with satisfactory results. Neither bowel nor urethral injuries were recorded, and no evidence of bladder penetration was observed. With the TVT-obturator, no intraoperative bleedings, postoperative field infections, or postoperative pelvic floor relaxations were noted.
Use of the TVT-obturator, a novel midurethral sling, seems to reduce the incidence of some of the operative complications associated with the TVT, primarily bladder penetration and postoperative outlet obstruction. The early therapeutic results and the cost-effectiveness of the novel TVT-obturator appear similar to those reported for common TVT surgery. However, long-term comparative data collection will be required to enable drawing solid conclusions regarding the appropriate position of this operative technique within the spectrum of anti-incontinence operations.
