Seija Ala-Nissilä

Objective Cure Rates and Patient Satisfaction After the Transobturator Tape Procedure During 6.5-Year Follow-Up

STUDY OBJECTIVE To report the subjective and objective outcomes and patient satisfaction with the outside-in transobturator tape (TOT) procedure during long-term follow-up. DESIGN Clinical follow-up study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS One hundred ninety-one women who underwent the TOT procedure. Of these, 66% had stress urinary incontinence and 34% had mixed urinary incontinence, and 45% underwent concomitant surgery. INTERVENTIONS Patients underwent surgery between May 2003 and December 2004 using the TOT procedure. After a mean follow-up of 6.5 years, postal questionnaires and an invitation for a follow-up visit to the outpatient clinic were sent to the patients. Objective cure was defined as a negative result of a stress test and no repeat operation because of stress urinary incontinence during follow-up. Subjective outcome was evaluated using the following validated questionnaires: UISS (Urinary Incontinence Severity Score), DIS (Detrussor Instability Score), VAS (visual analog scale, 0-100), short versions of the IIQ-7 (Incontinence Impact Questionnaire-7) and UDI-6 (Urogenital Distress Inventory-6), and the EQ-5D and EQ-5D VAS. Patient satisfaction was evaluated using a self-tailored questionnaire. MEASUREMENTS AND MAIN RESULTS Of 191 patients, 139 (73%) were evaluated after a mean follow-up of 6.5 years. Objective and subjective cure rates were 89% and 83%, respectively. Of the patients with genuine stress urinary incontinence, 92% were completely or quite satisfied with the surgery, and 76% of the patients with mixed urinary incontinence were satisfied (p < .001). Patients with body mass index >30 had significantly higher scores on the IIQ-7, UDI-6 (p < .01 for both), VAS (p < .001), UISS (p < .01), and DIS (p < .001), thus indicating a less favorable outcome of the procedure. CONCLUSION A high objective cure rate persisted after a mean follow-up of 6.5 years. Caution is advised when the TOT procedure is planned in patients with mixed urinary incontinence or severe obesity.

Tension-free vaginal tape procedure without preoperative urodynamic examination : Long-term outcome

Objectives:  To evaluate the long‐term outcome of the tension‐free vaginal tape procedure.

Posterior Transvaginal Mesh without Concurrent Surgery: How Does It have an Effect on the Untreated Vaginal Compartment?

Background/Aims: To report objective and subjective outcomes and adverse events after placement of Elevate® Posterior transvaginal mesh without concurrent surgery. Changes in non-affected anterior compartment were under special interest. Methods: A prospective study of Elevate® Posterior procedure in patients with symptomatic posterior compartment prolapse. Pelvic organ prolapse (POP) quantification (POP-Q) measurements and Pelvic Floor Dysfunction Inventory-20 (PFDI-20) and POP/urinary Incontinence Sexual Questionnaire (PISQ-12) questionnaires were used. Primary outcome was the incidence of de novo anterior prolapse. Secondary outcomes were complication rate and posterior compartment objective and subjective cure. Results: A total of 111 women underwent an Elevate® Posterior mesh procedure and 109 attended a control visit at 3 months. De novo anterior prolapse emerged in 3.2-15% of the women, depending on the definition. Posterior POP-Q stage ≤I was obtained in 92 (84%) women and leading edge at or above the hymen in 107 (98%) women. Bulge symptoms disappeared in 86% of the cases. One (0.9%) mesh exposure was detected. Reoperation rate was 2.8, and 3.7% patients experienced postoperative pain. PFDI-20 and PISQ-12 scores improved significantly. Conclusions: A trend of de novo prolapse formation in the non-affected vaginal compartment is observed. The Elevate® Posterior method is effective in terms of both objective and subjective outcomes. According to our results, the mesh exposure rate is low.

Vaginal cuff dehiscence is observed in a higher rate after total laparoscopic hysterectomy compared to other types of hysterectomy

Recently, it has been suggested that the occurrence of posthysterectomy vaginal cuff dehiscence has increased. Consequently, we evaluated the incidence of vaginal cuff dehiscence after different types of hysterectomies. Our hypothesis is that vaginal cuff dehiscence is more often associated with total laparoscopic hysterectomy (TLH) than other types of uterine removal.

Tension-Free Vaginal Tape—A Suitable Procedure for Patients With Recurrent Stress Urinary Incontinence

In a recent report, the 10-year reoperation rate for stress urinary incontinence (SUI) after primary failure of anti-incontinence surgery was 17%. A tension-free vaginal tape (TVT) procedure has been effective for primary surgical treatment of SUI and long-term results have been promising. A number of studies have investigated repeat surgery with TVT for recurrent SUI but only one—a retrospective study—used a control group. Moreover, the follow-up period after a repeat TVT has been short; there has been only one uncontrolled prospective 4-year study. This prospective follow-up study investigated the use of the TVT procedure in women with recurrent SUI and those with primary SUI with respect to cure rates, complications, and safety. All participants had a TVT—60 in the study group (recurrent SUI)—and 70 in the control group (primary SUI). The initial follow-up was at 2 months after surgery and patients completed a questionnaire 3 years later evaluating the success of the operation and urinary symptoms. At a mean of 8 years (range, 6-10 years), patient records were examined for data on any subsequent visits or additional surgery. The primary outcome measures were subjective cure, complications, and voiding symptoms. The rate of transient postoperative retention was similar in the 2 groups (recurrent SUI, 17% vs. primary SUI, 19%, P = 0.78). No significant difference was found between the groups in the number of complications (recurrent SUI, 20% vs. primary SUI, 13%, P = 0.27). Spontaneous micturition resumed in all patients by the 10th postoperative day. At the 2-month follow-up visit, 85% of the patients in recurrent SUI group and 94% of those in the primary SUI group were free of SUI and completely satisfied with the outcome (P = 0.096). These data were almost identical at 3 years. Major complications following surgery were rare. At 2 months, 22% of the recurrent SUI patients and 19% of the primary SUI patients had de novo urge symptoms (P = NS); at 3 years, the rate of voiding difficulties was 17% in the primary SUI group and increased to 33% in the recurrent SUI group (difference between groups, P = 0.037). Subjective voiding dysfunction (feeling of incomplete emptying with or without recurrent urinary tract infections) was reported by 5 patients (8.3%) in the recurrent SUI group and in 17 patients (24%) in the primary SUI group at 3 years after the operation (P = 0.022). These findings suggest that TVT is safe and effective when performed for primary or recurrent SUI. There are no apparent differences in cure and complication rates after TVT between patients with and without previous SUI surgery.