J Korean Continence Soc.  2007 Jun;11(1):19-23.

The Difference of Pelvic Floor with Dynamic MRI before and after Tension Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

• Sohn DW
• Park DJ
• Kim SD
• Kim SJ
• Jung YS
• Cho KJ
• Choi HW
• Kim DB
• Kim HW
• Cho YH
• Kim SW

Abstract

PURPOSE: Tension-free vaginal tape(TVT) procedure is an effective surgical procedure for the treatment of female urinary stress incontinence. The purpose of this study was to evaluate the changes of pelvic floor MR imaging findings after tension-free vaginal tape procedure on stress urinary incontinent women.
MATERIALS AND METHODS
Thirty two women with complaint of stress urinary incontinence(mean age, 56 years; age range 32~73 years) were included in this study. Pelvic floor MR imaging were performed preoperatively and one month after surgery. The position of the bladder neck in relation to the pubococcygeal line, the position of the bladder neck in relation to a perpendicular line through the posterior edge of symphysis pubis, the angle of urethral inclination were measured. We also measured the position of anterior wall of the urethra in relation to posterior edge of the symphysis pubis and cystocele during resting and pelvic straining and thickness of the anterior wall. We compared all parameters between resting and stress.
RESULTS
Twenty nine patients(91%) had normal voiding pattern after TVT procedure. three patients(9%) had voiding difficulty. The position and mobility of the bladder neck during straining showed significant improvement after surgery(p<0.01). During straining, the length between the urethra and the inferior edge of the pubic symphysis with mid-urethra angulation was shorten in twenty eight patients(88%). There is no significant difference among three groups in all parameters. However, 3 patients with voiding difficulty had the significant high bladder neck and moderate cystocele.
CONCLUSION
The TVT procedure provides decrease of urethral hypermobility and increase of mid-urethral angulation. MR imaging demonstrate well that urinary continence after surgery is most probably achieved by creating a dynamic mid-urethral knee angulation by which the urethra is closed at stress. Postoperative voiding difficulty may be related to remaining cystocele and high bladder neck.

Keyword

Magnetic resonance imaging; Urinary incontinence

MeSH Terms

Cystocele
Female*
Humans
Knee
Magnetic Resonance Imaging*
Neck
Pelvic Floor*
Pubic Symphysis
Suburethral Slings*
Urethra
Urinary Bladder
Urinary Incontinence*
Urinary Incontinence, Stress