Correlation of Morphological Alterations and Functional Impairment of the Tension-Free Vaginal Tape Obturator Procedure
Received 17 May 2008 published online 14 November 2008.
Refers to article:
Pubo-Urethral Ligament Injury Causes Long-Term Stress Urinary Incontinence in Female Rats: An Animal Model of the Integral Theory
, 17 November 2008
John C. Kefer, Guiming Liu, Firouz Daneshgari
The Journal of Urology
January 2009 (Vol. 181, Issue 1, Pages 397-400) Abstract |
Full Text |
Full-Text PDF (834 KB)
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.
aDivision of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
bSchools of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
cNutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan, Republic of China
dDepartment of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan, Republic of China
eSchool of Medicine, Fu Jen Catholic University, Taipei, Taiwan, Republic of China
Correspondence: Department of Obstetrics and Gynecology, Cathay General Hospital, 280, Ren-Ai Rd., Section 4, Taipei, 106, Taiwan, Republic of China (telephone: 886-9-68701383; FAX: 886-2-27094693)
For another article on a related topic see page 397.
Supported by National Science Council Research Grants NSC 95-2314-B-195-019-MY2 and NSC 96-2314-B-281-003, Mackay Memorial Hospital Research Grant 9702 and Cathay General Hospital Research Grant CT9560.
ABSTRACT