1. Results of tension free vaginal tape (TVT) versus tension free tape obturator (inside-outside TVT-O) in the surgical treatment of female stress urinary incontinence
Rosita Aniuliene,
Prof. of Lithuanian University of Health Science, Lithuania
President of Lithuanian Association of Urogynecology

3. KAUNO MEDICINOS UNIVERSITETO
AKUŠERIJOS IR GINEKOLOGIJOS KLINIKA

5. Surgical treatment of SUI
Laparoscopic colposuspension
Open retropubic colposuspension
Suburethral slings
Tension free vaginal tape
Transobturator foramen tape
Anterior vaginal repair (anterior colporraphy)
Needle suspension

6. Cochrane DB, NICE guidelines, ICS guidelines
Open retropubic colposuspension may be more likely to cure stress incontinence compared with anterior vaginal repair at 1-5 years. Complication rates are similar to those with other surgical procedures, but are higher than with non-surgical treatments.
Suburethral slings, tension free vaginal tape (TVT), transobturator foramen procedures (TOT, TVT-O), and needle suspension may be as effective as open retropubic colposuspension in curing stress incontinence over 5 years. Complications of tension free vaginal tape include bladder perforation.
Laparascopic colposuspension seems to be as effective over 5 years as open retropubic colposuspension or tension free vaginal tape.
Cochrane DB, NICE guidelines, ICS guidelines

7. TVT golden standard by proving same effectiveness as colposuspension
TVT became golden standard for SUI surgery in women after proving the same effectiveness as colposuspension. The study by Ward and Hilton was a milestone for TVT.

8. TVT – golden standard in SUI surgery
Reference: Nilsson CG et al, Int Urogynecol J 2008: 19:

9. Analysis of TVT operation at the Obstetrics and Gynaecology Clinic of LUHS

10. Objectives
Estimate the results and complications of TVT and TVT-O procedures

12. Study design
A prospective study using a standardized preoperative and postoperative protocol

13. Material TVT operation TVT-O operation TVT Exact operation
114 women were operated and followed up during study period: –
TVT-O operation
307 women were operated and followed up during study period: –
TVT Exact operation
16 women were operated and followed up during study period: –

14. Inclusion criteria
All patients had typical medical history of stress incontinence
The degree of the incontinence was 2-3 according to Ingelman-Sundberg scale
Patients with urge symptoms were treated preoperatively with anticholinergics and HRT

15. Methods
A medical history and urinary diary was taken of the duration and the severity of the stress incontinence
A gynecological examination was performed
A stress provocative test was performed in the supine and standing positions with a comfortably filled bladder (300ml) before and post operation
A quality of life evaluation was undertaken

16. Methods II
Urodynamic evaluation was performed by clinical indications for 30% of patients
Foley catheter was left for 24 h after TVT operation and 6 h after TVT-O operation.
The postoperative evaluation included operation time, complications, hospital stay and postoperative evaluation after 1 year was carried out.

17. Patients characteristics
TVT (n=114)
T VT Exact (n=16)
TVT-O (n=307)
Age ± SD
51 ± 10,1
50 ± 8,9
49 ± 9,5
POP Q system: Stage 1
Stage 2 26 14 51 22 2 29
Follow up period (months) 12
BMI, kg/m2
27,9 ± 4,0
28,5±3,5
28,2 ± 3,8
Number of birth
2,6 ±1,1
2,1 ±1,1
2,5 ± 1,2
Birth weight > 3500g
49 ± 1,2
9 ± 1,1
61 ± 1,3
Menopause (1-30 years) 48 5 57
Irritated bladder symptoms 6 1 10
Urinary incontinence period
6,5 ± 3,1
4,8 ± 2,7
7,5 ± 2,4
Hysterectomy in the past 15
Operated incontinence in the past 16 45

18. TVT and TVT-O procedures register data
Register parameters
TVT (n=114)
TVT Exact (n=16)
TVT-O (n=307) P
Effectiveness of procedure
94,6%
100% NS
Duration of procedure
27 ± 7,1
20 ± 11,1
19 ± 5,6
P<0,05
Hospital stay (days)
4,0 ± 1,6
4,5 ± 1,5
1,5 ± 0,5
Anesthesia: General
13 (11,4%)
2 (0,6%)
Local
2 (1,8%)
Lumbar
95 (83,3%)
1 (6,3%)
22 (7,1%)
Intravenous
4 (3,5%)
15 (93,7%)
283 (92,6%)
Bladder drainage: interrupted catheterization
18 (15,8%)
6 (37,5%)
10 (3,2%)

19. Postoperative complications
TVT (n=114)
TVT Exact (n=16)
TVT-O (n=307) P No
81 (71,0%)
8 (50%)
283 (92,2%)
P<0,05
Suprapubic hematoma
1 (0,8%)
1 (6,3%) NS
Wound bleeding in vagina
2 (1,8%)
3 (0,9%)
Bladder perforation
Postoperative urinary retention
18 (15,8%)
6 (37,5%)
10 (3,2%)
Symptoms of irritated bladder
6 (5,3%)
Infection of urinary tract
5 (4,4%)
2 (0,6%)
Temperature >380 C

20. Procedures combined with TVT (n=35)
Anterior suturing of vagina (22,1%)
( colporrhaphia anterior )
Mesh for cystocele repair (1,7%)
Posterior suturing of vagina (3,5%)
( colpoperineoplastic )
Diathermoconisation (1,7%)
Hysteroscopy, D/C (1,7%)

21. Procedures combined with TVT-O (n=78)
Anterior suturing of vagina 41 (13,3%)
( colporrhaphia anterior )
Posterior suturing of vagina 22 (7,1%)
( colpoperineoplastic )
Vaginal hysterectomy 6 (1,9%)
Hysteroscopy, D/C 3 (0,9%)
Abdominal hysterectomy 1 (6,3%)
Diathermoconisation (6,3%)
Polypectomy (urethral) (6,3%)
Lipomectomy (perineal) 1 (6,3%)
Sphincterorrhaphy 1 (6,3%)
Laparascopy adnexectomy 1 (6,3%)

22. Procedures combined with TVT Exact (n=3)
Anterior suturing of vagina 1 (6,3%)
( colporrhaphia anterior )
Posterior suturing of vagina 1 (6,3%)
( colpoperineoplastic )
Polypectomy of cervix 1 (6,3%)

23. Conclusions
TVT and TVT-O operations are very effective procedures while curing female stress incontinence after 12 months of follow-up.
TVT-O procedure has a shorter operation time and hospital stay.
TVT-O had lower complications rate that TVT procedure.
TVT Exact operation had 50% complications, but effectiveness after 2 months was 100%.

24. References

25. Thank you for your attention