Correlation of Morphological Alterations and Functional Impairment of the Tension-Free Vaginal Tape Obturator Procedure

Purpose

We explored the morphological features associated with functional impairment in patients undergoing the tension-free vaginal tape obturator procedure.

Materials and Methods

We retrospectively reviewed the records of 98 women who underwent the tension-free vaginal tape obturator procedure alone or with concomitant pelvic surgery. Postoperative assessment included a symptom questionnaire, ultrasound cystourethrography and a cough stress test. During followup the measures of postoperative functional impairment included a positive cough stress test, new onset voiding dysfunction and the worsening or progression of urge symptoms.

Results

Median followup was 22 months. During followup 11 women had a positive cough stress test, 22 had voiding dysfunction and 12 had worsening or new onset urge symptoms. Failure was associated with 4 variables on multiple logistic regression analysis, including absent urethral encroachment at rest (OR 16.63, 95% CI 1.87–147.85, p = 0.01), bladder neck funneling (OR 8.27, 95% CI 1.99–34.26, p <0.01), a urethral location of less than the 50th percentile (OR 6.01, 95% CI 1.43–25.25, p = 0.01) and a resting tape angle of less than 165 degrees (OR 5.21, 95% CI 1.15–23.54, p = 0.03). A resting tape distance of less than 12.0 mm (OR 3.00, 95% CI 1.44–6.26, p <0.01) and urethral encroachment at rest (OR 2.86, 95% CI 1.30–6.30, p <0.01) were the variables predictive of postoperative voiding dysfunction. Bladder neck funneling was the only risk factor for postoperative urge symptoms (p <0.01).

Conclusions

The tension-free vaginal tape obturator procedure achieves its effectiveness in a process of biological reaction and mechanical interaction between the tape and urethra. When this mechanical interaction is too great or too little, there is functional impairment after the procedure.

Key Words: urethra, urinary incontinence, stress, suburethral slings, vagina, ultrasonography

Abbreviations and Acronyms: TVTO, tension-free vaginal tape obturator procedure