Fig 3 - uploaded by Gautier Chene
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TVT-O at rest ( frontal view ): the tape is identified in the form of a hyper-echoic image stretching from one end of the urethra to the other
Source publication
The aim of this study was to compare ultrasonographic findings on tape position, angulation and mobility following three surgical anti-incontinence procedures (trans-obturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape obturator (TVT-O)) and to correlate these data with clinical signs of cures and failures and de novo vo...
Similar publications
Objective
To evaluate the performance of retropubic midurethral slings (MUS) for the treatment of female stress urinary incontinence (SUI) at a certified continence center and to identify risk factors for sling failure.
Methods
This was a single‐center cohort study including women who underwent a retropubic MUS procedure for SUI between 2012 and 2...
Background: Stress urinary incontinence is a symptom or sign indicating that the woman has involuntary loss of urine associated with exertion in the absence of detrusor contraction. It has a significant impact on quality of life. TOT insertion is a popular procedure being done now. Studies related to quality of life assessment following Trans obtur...
Objectives
To present the first experience in Iraq of autologous rectus fascia sling (RFS) procedures and transobturator tape (TOT) for treating female stress urinary incontinence (SUI), and to review the validity of the RFS in the era of synthetic tapes.
Patients and methods
From December 2004 to July 2012, 80 female patients with SUI were enroll...
The aim of this prospective multicenter study was to evaluate the safety and efficacy of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence. Four hundred and four women underwent the TVT procedure. Their mean age was 57 years (range 31-83). The median follow-up time was 21 months (range 12-35). The subjective a...
Purpose:
Despite reports of persistent stress urinary incontinence (SUI) in patients after the midurethral sling (MUS) procedure, there is no widely accepted definition or cause of the condition. In many cases, the mesh implanted in the previous MUS procedure has been found to have migrated proximally. The aim of this study was to evaluate the eff...
Citations
... The resting position of the tape (within the TOT and TVT-O groups exclusively) demonstrated a correlation with clinical improvement. It was observed that a greater angle of the tape at rest was notably linked to the recurrence of SUI [51]. ...
... Recent findings indicate that the sling's placement tends to remain constant throughout observation [25], mirroring the observations by Majkusiak et al., who also reported stability in the sling's location over time [27]. Interestingly, other studies validated this observation for the TOT approach, although the TOT method involves a more extensive sub-urethral dissection compared to TVT or TVT-O, and therefore one might raise concerns regarding the potential for tape migration towards either the bladder neck or the urethral meatus (this situation would most likely occur directly after the procedure, as a result of the tape shifting when the patient is upright) [51]. ...
... In a randomized clinical trial of 92 patients undergoing TVT or TOT, 37.5% in the TVT group and 9.7% in the TOT group experienced retention up to seven days post-surgery, with no significant difference in cases lasting over seven days [65]. Chene et al.'s analysis of TVT, TOT, and TVT-O patients showed de novo voiding difficulties in 20%, 13%, and 13%, respectively [51]. ...
Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.
... The importance of ultrasound in the evaluation of MUS relies on defining its position and its behavior during the Valsalva maneuver, and the correlation with symptoms and post-surgical complications [3][4][5]. Much research has been published, aiming to elucidate the mechanism of action of tapes; most of this research was performed in postoperative patients with tension-free vaginal tape (TVT), trans-obturator tape (TOT), and transobturator tension-free vaginal tape (TVT-O) [6][7][8][9][10][11][12]. In these studies, different criteria has been evaluated: the compression exerted by the TOT on the urethra [6], the tape migration rate [7], the angulation between the two arms of the mesh [7], the position of the tape regarding the pubis [8,10] or its location with respect to the urethra [12], and the mobility and funneling of the bladder neck [11]. ...
... Much research has been published, aiming to elucidate the mechanism of action of tapes; most of this research was performed in postoperative patients with tension-free vaginal tape (TVT), trans-obturator tape (TOT), and transobturator tension-free vaginal tape (TVT-O) [6][7][8][9][10][11][12]. In these studies, different criteria has been evaluated: the compression exerted by the TOT on the urethra [6], the tape migration rate [7], the angulation between the two arms of the mesh [7], the position of the tape regarding the pubis [8,10] or its location with respect to the urethra [12], and the mobility and funneling of the bladder neck [11]. There is very little published on the ultrasound assessment of SIMS: on the one hand, it would be logical to think that SIMS should behave like the rest of the tapes (TOT, TVT and TVT-O) and, therefore, to believe that they present a similar ultrasound appearance but, on the other hand, there are no studies on this matter. ...
... Much research has been published, aiming to elucidate the mechanism of action of tapes; most of this research was performed in postoperative patients with tension-free vaginal tape (TVT), trans-obturator tape (TOT), and transobturator tension-free vaginal tape (TVT-O) [6][7][8][9][10][11][12]. In these studies, different criteria has been evaluated: the compression exerted by the TOT on the urethra [6], the tape migration rate [7], the angulation between the two arms of the mesh [7], the position of the tape regarding the pubis [8,10] or its location with respect to the urethra [12], and the mobility and funneling of the bladder neck [11]. There is very little published on the ultrasound assessment of SIMS: on the one hand, it would be logical to think that SIMS should behave like the rest of the tapes (TOT, TVT and TVT-O) and, therefore, to believe that they present a similar ultrasound appearance but, on the other hand, there are no studies on this matter. ...
It would be logical to think that single-incision mini-slings (SIMS) should behave like the rest of the tension-free vaginal tape and, therefore, to believe that they present a similar ultrasound appearance, but there are no studies on this matter. Therefore, the main aim of our research is to determine which ultrasound parameters are associated with stress urinary incontinence (SUI) in patients carrying SIMS. A prospective observational study was carried out including 94 patients who were candidates for SUI corrective surgery with SIMS between 1 January 2021 to 31 December 2021 at the Universitary Hospital of Valme (Seville, Spain). A transperineal ultrasound evaluation was performed (six months after surgery) in order to study: the bladder neck–symphyseal distance, the posterior urethro–vesical angle, the pubic symphysis–tape gap, the tape–urethral lumen distance, the sagittal tape angle, the tape position, the concordance of movement between the tape and the urethra, and the axial tape angle. A total of 92 patients completed the study (63 asymptomatic and 29 symptomatic). Statistical differences were observed in the concordance of movement between the tape and the urethra (84.1% vs. 25.0%; p: 0.001) and in the axial tape angle at rest (139.3 ± 19.0 vs. 118.3 ± 15.4; p: 0.003) and at Valsalva (145.1 ± 20.2 vs. 159.1 ± 9.0; p: 0.034). Sagittal tape angle at rest was higher in urge urinary incontinence (UUI) patients (132.5 ± 35.7 vs. 143.3 ± 29.8; p: 0.001) and mixed urinary incontinence (MUI) patients (132.5 ± 35.7 vs. 157.8 ± 23.6; p: 0.025) compared to asymptomatic patients. In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to define continence in patients with SIMS.
... [9][10][11] Although the tape location (related to the middle third of the urethra) is still debated as a factor impacting the surgical outcome, tape tension is definitively accepted to have a role in surgical efficacy and complications related to suburethral tape procedures. [11][12][13] As known, obstruction represents the most critical disorder and, if it is not diagnosed and quickly treated, it could lead to permanent urethral stenosis. In addition, this kind of stenosis is difficult to treat with the urethrolysis technique because of the toughness of the relationship between the sling and scar tissue; it is a delicate procedure with a high incidence of complications such as hemorrhages, relapses of stenosis, recurrent urinary infections, and urethra-vaginal fistulas. ...
Objective
The purpose of this study was to evaluate the feasibility and accuracy of postoperative translabial ultrasound to assess the position of the tape implanted with the tension‐free transobturator tape technique.
Methods
We enrolled women with clinically and urodynamically proven type I or II stress urinary incontinence who were referred for transobturator tape treatment.
Results
A total of 50 women underwent a transobturator tape procedure and were included in the analysis. We divided the patients into two study groups (group A and group B), characterized by normal and obstructed flow at least 30 days after the surgical procedure visit, respectively. We performed a translabial ultrasound evaluation to assess the suburethral localization of the sling. On the longitudinal scan, the distance between the bladder neck and the suburethral sling was >10 mm in all patients in group A (16.7 ± 1.6). On the contrary, the values in group B were ≤10 mm (5.3 ± 4.8).
Conclusion
Our findings highlight the role of a skilled sonographic operator performing translabial ultrasound as a first‐line method for evaluating postoperative transobturator tape procedure and sling positioning. Moreover, translabial ultrasound could be helpful to determine a “cutoff” of the bladder neck to sling distance, as this is related to the onset of the obstruction.
... Kiçik çanaq orqanlarının anatomofunksional dəyişiklikləri tibbi problem olmaqla yanaşı qadının həyat keyfi yyətinin pozulmasına səbəb ola bilir. Çanaq dibi xəstəlikləri ilə uroloji xəstəliklərin birlikdə rastlaşmasının yüksək faizi (85,5%), patoloji prosesin cavanlaşması problemin çoxəhatəli olmasını və tibbi sferadan kənara çıxmasını sübut edir (8, 14,17,21,25). ...
Ümumi ginekoloji xəstəliklərin quruluşundakı cinsiyyət orqanlarının prolapsusu və prolapsusu% 28-38.9% -dir. Genital prolapsusu olan qadınlarda sidik ifrazı% 50-84 nisbətində qeyd olunur. Daxili cinsiyyət orqanlarının prolapsusu və prolapsusu və stresli sidik tutmamaq üçün ümumi patofizyolojik şərtlər bu şərtləri diaqnoz və müalicə seçimində inteqrativ yanaşmalar tələb edən ayrılmaz bir tibbi problem kimi qəbul etməyə imkan verir.Pelvik döşəmənin disfunksiyası üçün cərrahi müalicə əsasdır. Son illərdə daxili cinsiyyət orqanlarının qarışıq xəstəlikləri və sidik ifrazı üçün cərrahlar getdikcə sintetik implantların istifadəsi ilə seçmə süni əməliyyatlara üstünlük verirlər. Bununla birlikdə, sintetik implantların istifadəsinin dərhal və uzunmüddətli nəticələri birmənalı deyil və əlavə araşdırma tələb edir. Komorbiditenin cərrahi müalicəsində əhəmiyyətli bir müvəffəqiyyətə baxmayaraq, cərrahi müdaxilələrin 9-30% -i sidik ifrazının aradan qaldırılmasına səbəb olmur. Bir sıra müəlliflərə görə, genital prolapsın təkrarlanma tezliyi 33 ilə 61.3% arasında dəyişir.
... Эхографию уретровезикального сегмента широко используют многие мировые и отечественные клиницисты [5][6][7], она позволяет до операции уточнить вид недержания мочи, степень повреждения структур тазового дна, а после операции -оценить качество хирургической коррекции. в частности, угол α является дифференциальным признаком, отличающим стрессовую инконтиненцию i и ii типов. ...
Hypothesis/Aims of study. At present, there is no doubt about the importance of the problem of female stress urinary incontinence (SUI) and the search for the best way to eliminate it. Sling operations in SUI treatment are the most popular in world and domestic practice. However, they are not without certain complications. In this regard, it becomes relevant to determine the factors for predicting their effectiveness and safety. The aim of this study was to conduct a comparative study of the effectiveness of two anti-stress operations: TVT-Obturator and urethrovesicopexy with vaginal flap, by using echography of the urethrovesical segment. Study design, materials and methods. During the period from 2011 to 2018, 105 incontinent patients were examined and operated on. Two groups were formed: Group 1 consisted of 52 patients who underwent TVT-Obturator surgery, Group 2 included 52 patients who underwent urethrovesicopexy with vaginal flap. In all patients, the anatomical topographic position of the bladder and urethrovesical segment, the internal urethral sphincter status, as well as the angles and were determined, based on which the conclusion about the type of SUI was made and, accordingly, the adequate method of surgical intervention was determined. Results. Before the operation, the angle averaged 37.2 10.11, with 24.7 4.64 a year after the operation and 26.8 3.72 five years after the operation. Rotation of the angle in the study groups 20 before surgery did not significantly affect the presence of long-term complications, urinary retention after a year and five years, and recurrence of urinary incontinence. After the operation, there was an increase in the angle after a year (p = 0.0032) and five years (p = 0.0035) and in the total urethral length after a year (p = 0.0022), but after five years, this parameter did not differ significantly from that before surgery (p = 0.29). Conclusion. TVT-Obturator and urethrovesicopexy with vaginal flap are equally effective (p 0.05) in the surgical treatment of female SUI in both the nearest postoperative period (96.2% and 94.3%, respectively) and the distant period (90.4% and 88.7%, respectively).
... Tape location and tension are the most frequently investigated factors that might affect surgical outcomes and can be assessed sonographically [8][9][10][11][12][13][14]. Ultrasound is a minimally invasive yet clinically achievable method of assessing tape placement. ...
... 5-020-03153 -8) contains supplementary material, which is available to authorized users. and their association with sonographic sling appearance [11,12,[14][15][16]. A study by Dietz et al. appeared to find that the narrower the distance between the sling and the symphysis pubis on ultrasound, the more likely a patient will remain continent [8]. ...
PurposeThe aim of this study was to assess the association between four-dimensional translabial ultrasound (4D-TLUS) features of the retropubic mid-urethral sling (MUS) and post-operative pelvic floor symptoms.MethodsA prospective cohort study was performed involving 100 women who had a solitary retropubic MUS (TVT Exact™) between Jan 2013 and Dec 2017 for urodynamic stress incontinence (SI) at a tertiary urogynaecological centre. All patients completed a standardised interview and had free flowmetry, prolapse evaluation and assessment for mesh exposure and tenderness. 4D-TLUS parameters measured included pelvic organ descent, levator ani status, sling–symphysis pubis (SP) gap at rest and Valsalva, angle formed by cranial and caudal ends of the sling, cranio-caudal and dorso-ventral sling–symphysis pubis distance at Valsalva. The primary outcome was treatment success as defined by patient report of cure or improvement and no objective demonstrable SI.ResultsEighty-nine (89%) patients reported treatment success. Two patients (2%) had mesh exposure; one was symptomatic with pain, requiring complete sling removal. There was a significant association between treatment success and a SP gap at Valsalva of 10–12 mm (p = 0.001); and independently with a SP angle at Valsalva of 45°–80° (p = 0.007). A narrower SP gap at Valsalva closer to 10 mm was associated with voiding symptoms (p = 0.036).Conclusion
Sling–pubis gap and sling–pubis angle at Valsalva appear to be significantly associated with treatment success in retropubic MUS. There is a significant association between a narrower sling–pubis gap at Valsalva and voiding symptoms.
... However, there are few studies that correlate the information obtained by 3D-US and the prognostic and predictive markers of SUI treatment with synthetic slings. 7 Therefore, the present study utilized translabial 3D-US 3 years after surgeries for the cure of SUI to evaluate and compare the spatial position of the polypropylene sling tape for 3 different SUI correction techniques: MUS using the retropubic approach (tension-free vaginal tape, TVT), the transobturator approach (tension-free vaginal tape-obturator, TVT-O), and the single-incision sling (tension-free vaginal tape-Secur, TVT-S). In addition, the relationship between the 3D-US findings and the objective/subjective cure rates and urgency-related symptoms was examined. ...
... Three-dimensional US was performed after voiding, with the patient in the lithotomy position, with the hips flexed and abducted; it was performed at rest, during the Valsalva maneuver, and during perineal contraction. The 3D-US equipment (Voluson 730 Expert, General Electric [GE] Healthcare, Zipf, Austria) included a convex volumetric transducer covered by a plastic transducer (4)(5)(6)(7)(8) with an acquisition angle of 85°. ...
... Three-dimensional US imaging of the pelvic floor is a noninvasive and reproducible technique for the evaluation of postoperative MUS, and it enables a dynamic assessment of the polypropylene sling tape, with good visibility during rest, pelvic floor contraction, and the Valsalva maneuver. 7 The BT found in the present study is consistent with previously published data. 18,19 In addition, for the majority of the patients (85.7%), the sling was located in the midurethra, and all other patients had slings located in the distal urethra (14.3%). ...
Objective Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of mid-urethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results.
Methods A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVT-O), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons.
Results Differences among the groups were found in the mean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVT-S = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVT-S = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; p = 0.630).
Conclusions The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.
... Others claim that the tape location along the longitudinal axis of the urethra is of little importance (7,17) . The tension of the tape, however, constitutes a commonly-acknowledged determinant of the TVT procedure's success (19,20) . Kociszewski et al. believe that, aside from the importance of the tape positioning along the longitudinal urethral axis, also its alignment with the transverse urethral axis, as well as the urethra's mobility may affect the outcome (13,14,18) . ...
Introduction:
Implants used to treat patients with urogynecological conditions are well visible in US examination. The position of the suburethral tape (sling) is determined in relation to the urethra or the pubic symphysis.
Aim of the study:
The study was aimed at assessing the accuracy of measurements determining suburethral tape location obtained in pelvic US examination performed with a transvaginal probe.
Material and methods:
The analysis covered the results of sonographic measurements obtained according to a standardized technique in women referred for urogynecological diagnostics. Data from a total of 68 patients were used to analyse the repeatability and reproducibility of results obtained on the same day.
Results:
The intraclass correlation coefficient for the repeatability and reproducibility of the sonographic measurements of suburethral tape location obtained with a transvaginal probe ranged from 0.6665 to 0.9911. The analysis of the measurements confirmed their consistency to be excellent or good.
Conclusions:
Excellent and good repeatability and reproducibility of the measurements of the suburethral tape location obtained in a pelvic ultrasound performed with a transvaginal probe confirm the test's validity and usefulness for clinical and academic purposes.
... Mesh material was readily seen using translabial ultrasonography, and pelvic floor ultrasonography has been used for the evaluation of pelvic organ prolapse and synthetic mesh placement after incontinence surgery [24,25]. Chene et al. concluded that larger angulations during rest had a significant association with SUI recurrence, and that closer angulations had a significant association with de novo urge incontinence and voiding disorders [26]. In our study, we did not find any correlation between mesh angle and incontinence recurrence. ...
ABSRACT:
PURPOSE: The primary aim of our study was to evaluate mesh movement on ultrasonography and to compare the relationship between suburethral mesh angle and incontinence recurrence.
METHODS:
This study was carried out at the University of Selcuk, Konya, Turkey, Beyhekim State Hospital, Konya, Turkey and the Mus State Hospital between September 2012 and January 2015. In total, the results from 109 patients were evaluated in the statistical analysis. The suburethral mesh angle (SMA) is the angle between the two arms of the trans-obturator tape (TOT) mesh under the urethra. This angle was measured at 10 days, 6 months and 1 year after surgery. Potential risk factors for incontinence recurrence and SMA were compared in logistic regression models. The best cut-off value for SMA was calculated to predict incontinence recurrence.
RESULTS:
The mean resting SMA did not change with time during follow-up (p = 0.373). However, when comparing coughing SMA values, the first day measurement was significantly different from the other measurements. Another comparison was performed according to the cSMA value at each visit. The difference was significant from the first day. Lung disease and the change in the SMA (cSMA) on day 10 were significant predictors of treatment failure. The cSMA on day 10 to predict first-year treatment failure was 10°, with 61% sensitivity and 96% specificity.
CONCLUSIONS:
Measurement of the SMA can be used as a prognostic factor in TOT surgery. Further research is required to determine the importance of SMA as a prognostic factor.
... open in the TOT and TVT-O treatments than in the TVT, and that a larger angle at rest is significantly associated with recurrent SUI [26]. At maximum retention, the angle closes through the traction of the two arms, with the lavatory plate raising the anterior vaginal wall. ...
We compared the effectiveness of the retropubic tension-free vaginal tape (TVT) and the transobturator inside-out tape (TVT-O) in treating symptoms of overactive bladder (OAB) in women with stress urinary incontinence (SUI).
Women with urodynamic SUI and OAB (mean urgency episodes ≥1 and frequency ≥8/24 hours on a 3-day voiding diary) were assigned to the TVT or TVT-O group. Preoperative measures were based on a urodynamic study, 3-day voiding diary, the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTSSF), and the urgency perception scale (UPS). At 12 postoperative months, the 3-day voiding diary, symptoms questionnaire, patient satisfaction, and standing stress test were assessed. The primary endpoint was change in the number of urgency episodes/24 hours from baseline to 12 months.
In this group of 132 women, 42 received TVT and 90 received TVT-O. The mean urgency episodes/24 hours decreased from 6.3±5.5 to 1.6±3.2 in the TVT group and from 5.1±4.4 to 1.8±3.0 in the TVT-O group. The mean percent change was significantly greater after TVT than after TVT-O (73% vs. 60%, P=0.049). All subscales of BFLUTSSF and UPS were significantly improved using either method, with significantly greater improvement seen in the quality of life (QoL) domain after TVT (P=0.002). There were no significant differences in the cure and satisfaction rates between the two groups.
Intervention with the TVT or the TVT-O significantly improved symptoms of OAB in women with SUI and OAB. Urgency and QoL significantly improved after TVT compared with that after TVT-O.
