The Change of Continence Indices after Tension Free Vaginal Tape Procedure

Kim, Seong Su; Sung, Bong Mo; Woo, Won Hee

Abstract

PURPOSE: This study was performed to assess the difference of the continence indices before and after the tension-free vaginal tape procedure (TVT).
MATERIALS AND METHODS
We reviewed retrospectively our experience with 30 patients treated with the TVT procedure for stress urinary incontinent women, between January 2002 and December 2003. A comprehensive medical history, physical examination, urinalysis, urine culture, voiding diary, uroflometry and cystourethrogram were performed preoperatively and 3 months after surgery. The positions and mobilities of the bladder neck and the urethra were compared preoperatively and postoperatively by cystourethrograms both at rest and during voiding. The surgical outcomes were evaluated by global satisfaction question, and the definition of success or failure determined by using Stamey's criteria. Multiple parameters, with regard to the uroflometry, and cystourethrogram were analyzed using chi-square tests.
RESULTS
In the 30 patients followed up, the TVT procedure was successful in 93.3% (cured 83.3%, improved 10%) 3 months after the procedure. The position and mobility of the bladder neck showed no significant difference before and after surgery, but significant change in the urethral knee angle in cured and improved patients during maximum straining was noted cystourethrographically on cured and improved patients during maximum straining. The preoperative peak flow rates and average flow rates were significantly decreased after surgery, but the residual urine was not. There were no serious complications related to the procedure.
CONCLUSIONS
The TVT procedure is an effective surgical procedure for the treatment of female stress urinary incontinence. The procedure seems neither to change the hypermobility nor to elevate the position of the bladder neck. Urinary continence after surgery is most probably achieved by creating a dynamic mid urethral kinking at stress.