Sonographic sling position and cure rate 10-years after TVT- O procedure

Ayman Tamma, Vesna Bjelic-Radisic, Susanne Hölbfer, Gerda Trutnovsky, Karl Tamussino, Thomas Aigmüller, Daniela Ulrich, Ayman Tamma, Vesna Bjelic-Radisic, Susanne Hölbfer, Gerda Trutnovsky, Karl Tamussino, Thomas Aigmüller, Daniela Ulrich

Abstract

Aim: To examine the position of the TVT-O sling 10 years postoperatively and its association with outcome.

Methods: A total of 124 patients who received a TVT-O sling at two centers in 2004 and 2007 were invited for follow-up. The position of the sling on perineal ultrasound was described relative to the bladder neck and the lower margin of the pubic symphysis at rest and on Valsalva. Objective cure was defined as a negative cough stress test at 300 ml. Subjective cure was evaluated with the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire (IOQ), Female Sexual Function Index Questionnaire (FSFI) and the Patient Global Impression of Improvement score (PGII).

Results: 78 of 124 patients (57%) were available for follow-up 10 years after surgery. I Eleven (14%) had undergone reoperation and were excluded. Tapes were visualized in the remaining 67 (54%) women. The subjective and objective cure rates in this sub-cohort were 67% (45/67) and 77% (52/67), respectively. In these 67 women the mean distances from the bladder neck to the proximal edge of the tape (BNTD) during Valsalva maneuver were significantly higher in cured women compared to the not-cured women (11.2 vs. 9.4mm). The distance between tape and urethra (TUD) was significantly lower in cured vs. not cured patients (2.6 vs. 4.1mm). All women with a TUD of >5mm (n = 5) were incontinent. Tape position was not associated with overactive bladder symptoms.

Conclusions: Tape position near the bladder neck and large distance to the urethra is associated with incontinence 10 years after TVT-O.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. The distance from the posterior…
Fig 1. The distance from the posterior side of the urethra at the bladder neck to the nearest, proximal edge of the tape was defined as the “bladder neck to tape distance” (BNTD) BNTD Bladder neck to tape distance; TP Tape percentile; TUD Tape-urethra distance.
Fig 2. The position of the tape…
Fig 2. The position of the tape in relation to the lower level of the pubic symphysis was expressed as the “craniocaudal tape distance” (CCTD) CCTD Craniocaudal tape distance.
Fig 3. Cured vs. none-cured women according…
Fig 3. Cured vs. none-cured women according to the stress cough test dependent on tape position relative to TUD and TP.
Fig 4. Cured vs. none-cured women according…
Fig 4. Cured vs. none-cured women according to the PGI-I dependent on tape position relative to TUD and TP.
Fig 5. Outcome of women with or…
Fig 5. Outcome of women with or without OAB symptoms dependent on tape position relative to TUD and TP.

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