1. Jose D Roman M.D. Braemar Hospital, Hamilton, NEW ZEALAND
Subjective outcome of 166 tension-free vaginal tape procedures performed by a single surgeon:
The Braemar experience
Jose D Roman M.D.
Braemar Hospital, Hamilton, NEW ZEALAND

2. Rationale for this study
Tension -free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) success is well documented
Need for reporting long-term outcomes (Cochrane Database review 2015)
Adverse effects of using vaginal mesh

3. Material and Methods 1. Ethical approval
2. Inclusion criteria: SUI demonstrated clinically and by
urodynamic testing
Exclusion criteria: Patients with detrusor overactivity
(with or without SUI) demonstrated by urodynamic testing-
Previous surgery for SUI- Prophylactic TVT procedure when
undergoing a Pelvic Organ Prolapse (POP)repair.
3. Number of patients: 231 TVT procedures for the
actual study

4. Material and Methods 4. Pre-operative evaluation
Urogynaecological history
24-h voiding diary
Urine analysis
Pelvic examination in the lithotomy position
Cough Stress test
Stage of the POP : Baden-Walker system
Urodynamic testing (Pessary for patients with significant POP)
Questionnaires: Urogenital Distress Inventory (UDI-6) and the
Incontinence Impact Questionnaire (IIQ-7)

5. Material and Methods 5. Operative technique
G.A and endotracheal intubation as in-patient
all procedures performed by one single surgeon
Ulmsten’s Technique, 1995.
If anterior colporrhaphy (anterior vaginal repair) needed then a separated incision
was performed for the insertion of the sling
Routine cystoscopy
IDC removed on postop day 1 and the residual bladder volume was calculated (scan)
6. FOLLOW UP
Postoperative assessment at 2 weeks- 8 weeks and long-term at the time of this
study (questionnaires)
SUCCESS: postoperative score greater than the threshold of the minimum
important difference (MID) of 11 Points: UDI-6 and 16 points: IIQ-7 when
compared to the preoperative score
7. Social Science Statistical Package for analysis

6. RESULTS CHARACTERISTICS OF THE STUDY GROUP: 166 patients MEAN
STANDARD DEVIATION
AGE (YEARS)
51.27
9.14
PARITY
2.7 1
BMI (KG/M2)
26.7
4.1
FOLLOW-UP (MONTHS) 58
28.56
PREVIOUS HYSTERECTOMY
37(22.29%)
CONCOMITANT POP REPAIR
111(66.87%)
LAPAROSCOPIC HYSTERECTOMY AND APICAL REPAIR
53(31.93%)
ANTERIOR/POSTERIOR REPAIR
46(27.71%)
LAPAROSCOPIC MESH SACROCOLPOPEXY
12(7.23%)
BMI : BODY MASS INDEX; POP: PELVIC ORGAN PROLAPSE

8. FIGURE 1. YEARLY UDI-6 SCORE MEANS BEFORE AND AFTER SURGERY AND THE YEARLY PERCENTAGE OF PATIENTS WHO ACHIEVED A REDUCTION BETWEEN THE PRE AND POSTOPERATIVE SCORE -MID > 11, VERSUS LENGTH OF FOLLOW-UP IN YEARS

9. FIGURE 2. YEARLY IIQ-7 SCORE MEANS BEFORE AND AFTER SURGERY AND THE YEARLY PERCENTAGE OF PATIENTS WHO ACHIEVED A REDUCTION  BETWEEN THE PRE AND POSTOPERATIVE SCORE - MID > 16, VERSUS LENGTH OF FOLLOW-UP IN YEARS

10. SUBJECTIVE SUI REPORTED BY THE 166 PATIENTS OF THE SURVEY
NUMBER OF PATIENTS
PERCENTAGE
NO SUI
133
80.1
Mild SUI 23
13.9
Moderate SUI 9
5.4
Severe SUI 1
0.6
SUI: Stress urinary incontinence

11. SATISFACTION WITH THE TVT PROCEDURE
LIKERT SCALE SATISFACTION
AVERAGE
0.82 +/- 0.18
(score of 0.75 or more)
133 (83.3%)

12. FIGURE 3. YEARLY PERCENTAGE OF PATIENTS WHO REPORTED NO SUI AT THE
TIME OF THE STUDY - VERSUS – THE LENGTH OF FOLLOW-UP

13. SURGICAL COMPLICATIONS
Intra-operative
1: Vaginal bleeding
(8 weeks)
1: Persistent SUI and recurrent cystocele
Late Post-operative
1: Recurrent SUI at 4/52
2: Further TVT sling and 1: Referred to Urogynaecologist

14. Conclusions
1. The TVT procedure in a population in which 67% had a POP repair performed concomitantly was associated with a subjective cure rate of 80%
2. The TVT procedure, with or without concomitant POP repair, was found to be a safe procedure, with a low peri-operative complication rate and a patient-reported satisfaction rate of 83.3%
3. The overall success rate and quality of life effects did not decline significantly within 10 years after TVT surgery

15. THANK YOU !!