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Abstract
Purpose: Evaluate the efficacy and safety of adjustable TVT (Tension - free Vaginal Tape) procedure for treatment of complicated SUI (Stress Urinary Incontinence) in women, which has a high probability of failure if using classical methods of mid - urethral sling such as TVT and TOT (Trans Obturator Tape).
Methods: This is a case series study, conducted at the Department of Functional Urology, Ho Chi Minh city University Medical Center. Selected patients were complicated SUI cases in women. Complicated SUI means a high probability of failure if standard TVT, TOT techniques are applied, in particular if at least one of the following factors is present: 1) intrinsic sphinter deficiency; 2) nonurethral hypermobility; 3) prehistory of surgical treatment for SUI that failed. Sling used was Adjustable Sling of AMI company (Austria). Technique of placing sling is according the principle of TVT. Adjust sling tension early if the patients still have urinary incontinence or difficulty of urination.
Results: From Ostober 2020 to May 2022, 10 women with complicated SUI were operated by adjustable TVT technique, with a mean age of 57.4 years. Mean operating time was 39 minutes. Mean follow - up was 8.4 months. 5 cases had to adjust the tension of sling after surgery: 5 times to decrease the tension due to difficulty urinating or urinary retention after removing the catheter, 2 times to increase the tension due to stress urinary leakage and (2 patients had to adjust 2 times, another one had to adjust 3 times). At the last follow - up visit, 9/10 patients had no urinary leakage, 1/10 had mild difficulty urinating, none of them showed mesh erosion.
Conclusion: Adjustable TVT is a safe, effective, fairy easy method for treatment of complicated SUI in women, which can help to reduce failure rate compared to classical methods of mid - urethral sling. We note that the adjustment should be done in the first week after surgery. After this time, it will be very difficult because the sling is already adhered by the fibrous tissue formation.
References
Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. International Urogynecology Journal. 1996;7:81-86.
Delorme E. La bandelette trans - obturatrice: Un procedé mini-invasif pour traiter l’incontinence urinaire d’effort de la femme. Prog Urol. 2001;11.
Ford AA, Rogerson L, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2015:Cd006375.
Schmid C, Bloch E, Amann E, Mueller MD, Kuhn A. An adjustable sling in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Neurourol Urodyn. 2010;29:573-7.
Nguyễn Văn Ân, Vũ PH. Vai trò của phẫu thuật TVT trong thời đại phổ biến của phẫu thuật TOT điều trị tiểu không tự chủ do áp lực. Y học TPHCM. 2019;23:91-95.
Kim HG, Park HK, Paick SH, Choi WS. Comparison of Effectiveness between Tension - Free Vaginal Tape (TVT) and Trans - Obturator Tape (TOT) in Patients with Stress Urinary Incontinence and Intrinsic Sphincter Deficiency. PLoS One. 2016;11:e0156306.
Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A, et al. Three - year follow - up of tension - free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol. 2012;119:321-7.
Zubke W, Gruber I, Gardanis K, Wallwiener D. Tensionfree vaginal tape (TVT): our modified technique - effective solutions for postoperative TVT correction. Gynecological Surgery. 2004;1:111-118.
McGuire EJ, Cespedes RD, O’Connell HE. Leak-point pressures. Urol Clin North Am. 1996;23:253-62.
Giberti C, Gallo F, Cortese P, Schenone M. The suburethral tension adjustable sling (REMEEX system) in the treatment of female urinary incontinence due to ‘true’ intrinsic sphincter deficiency: results after 5 years of mean followup. BJU Int. 2011;108:1140-4.
Oh TH, Shin JH, Na YG. A Comparison of the Clinical Efficacy of the Transobturator Adjustable Tape (TOA) and Transobturator Tape (TOT) for Treating Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency: Short - term Results. Korean J Urol. 2012;53:98-103.
Ugurlucan FG, Yasa C, Adjustable midurethral slings in the treatment of female stress urinary incontinence, in Synopsis in the management of urinary incontinence. 2017, IntechOpen.
Clemons JL, LaSala CA. The tension-free vaginal tape in women with a non - hypermobile urethra and low maximum urethral closure pressure. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:727-32.
Han JY, Lee KS, Choo MS. Management of Recurrent or Persistent Stress Urinary Incontinence after Mid-urethral Sling. Low Urin Tract Symptoms. 2012;4 Suppl 1:95-101.
Yoo DH, Noh JH. Readjustable sling procedure for the treatment of female stress urinary incontinence with intrinsic sphincter deficiency: preliminary report. Korean Journal of Urology. 2010;51:420.
Kim WB, Lee SW, Lee KW, Kim JM, Kim YH, Kim ME. Readjustable midurethral sling (REMEEX system) in obese women. Investig Clin Urol. 2019;60:488-495.
Shkarupa D, Kubin N, Staroseltseva O, Shapovalova E. Adjustable transobturator sling for the treatment of primary stress urinary incontinence. Int Urogynecol J. 2018;29:1341-1347.
| Published | 02-01-2025 | |
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| Issue | No. 81 (2022) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.81.9 | |
| Keywords | Tiểu không tự chủ khi gắng sức; Suy cơ thắt nội tại; TVT hiệu chỉnh được Stress Urinary Incontinence; Intrinsic Sphincter Deficiency, Adjustable Tension - free Vaginal Tape |
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