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Operative shortening of the sling as a second-line treatment after TVT failure.

Gibas A, Matuszewski M, Michajłowski J, Krajka K - Cent European J Urol (2011)

Bottom Line: The 12-month follow-up showed no side-effects.In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively).The negative emotions connected with SUI significantly decreased after the second procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology Medical University of Gdańsk, Poland.

ABSTRACT

Introduction: Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure.

Materials and methods: Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients.

Results: All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure.

Conclusions: The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure.

No MeSH data available.


Related in: MedlinePlus

Operative shortening of the sling. Step 1: (left image) – incision of the anterior vaginal wall and preparation of the sling. Step 2: (middle image) – excision of a small fragment of the sling. Step 3: (right image) – re-anastomosing both ends of the sling by non-absorbable suture (two interrupted sutures).
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Figure 0001: Operative shortening of the sling. Step 1: (left image) – incision of the anterior vaginal wall and preparation of the sling. Step 2: (middle image) – excision of a small fragment of the sling. Step 3: (right image) – re-anastomosing both ends of the sling by non-absorbable suture (two interrupted sutures).

Mentions: The procedure was done in the lithotomy position under spinal anesthesia. After the incision of the anterior vaginal wall, the fragment of sling was exposed and a 5-8 mm fragment of it was excised (urethrolysis was not performed). The remaining ends of the tape after excision were mobilized only enough to make the re-anastomosis possible. We used a non-absorbable suture 2-0 to perform the re-anastomosis, which created more adequate support for the urethra. The small incision in the anterior vaginal wall was closed with interrupted sutures (Caprosyn 3-0). After the procedure, an 18 F Foley catheter was inserted for one day (Fig. 1).


Operative shortening of the sling as a second-line treatment after TVT failure.

Gibas A, Matuszewski M, Michajłowski J, Krajka K - Cent European J Urol (2011)

Operative shortening of the sling. Step 1: (left image) – incision of the anterior vaginal wall and preparation of the sling. Step 2: (middle image) – excision of a small fragment of the sling. Step 3: (right image) – re-anastomosing both ends of the sling by non-absorbable suture (two interrupted sutures).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921729&req=5

Figure 0001: Operative shortening of the sling. Step 1: (left image) – incision of the anterior vaginal wall and preparation of the sling. Step 2: (middle image) – excision of a small fragment of the sling. Step 3: (right image) – re-anastomosing both ends of the sling by non-absorbable suture (two interrupted sutures).
Mentions: The procedure was done in the lithotomy position under spinal anesthesia. After the incision of the anterior vaginal wall, the fragment of sling was exposed and a 5-8 mm fragment of it was excised (urethrolysis was not performed). The remaining ends of the tape after excision were mobilized only enough to make the re-anastomosis possible. We used a non-absorbable suture 2-0 to perform the re-anastomosis, which created more adequate support for the urethra. The small incision in the anterior vaginal wall was closed with interrupted sutures (Caprosyn 3-0). After the procedure, an 18 F Foley catheter was inserted for one day (Fig. 1).

Bottom Line: The 12-month follow-up showed no side-effects.In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively).The negative emotions connected with SUI significantly decreased after the second procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology Medical University of Gdańsk, Poland.

ABSTRACT

Introduction: Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure.

Materials and methods: Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients.

Results: All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure.

Conclusions: The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure.

No MeSH data available.


Related in: MedlinePlus