Mariusz Blewniewski, Waldemar Różański
- II Klinika Urologii UM WSS im. M. Kopernika w Łodzi
Introduction. Stress urinary incontinence /SUI/ occurs as a result of downward displacement of the bladder neck and urethra due to flaccidity of the supporting tissues and intrinsic urethral sphincter deficiency. Among the numerous methods of treatment used in SUI according to the stage of the disease, procedures involving suspension of the urethra are the most frequent ones.
Objectives. The objective of this study is to present the TVT S System (tension-free vaginal tape secure system) a new, minimally invasive sling procedure for the treatment of stress urinary incontinence in women
Materials and methods. From February 2007 to January 2008, 10 urethral suspension procedures with TVT Secur treating urinary incontinence in women were performed in the Department. The patients’ age ranged from 55 to 76, with the mean of 60 years. The diagnosis of SUI was established on the basis of anamnesis, gynecological examination, US and urodynamic exam. The average duration of this mini-invasive procedure is ca. 15 min., and of hospitalization 1-2 days. The patients were followed up post-operatively for 3 to 12 months. TVT-Secur* System Device - the mesh consists of a 1.1 x 8 cm PROLENE laser cut mesh tape, which is coated on both ends (2 cm on each end) with an absorbable fleece material. The sandwiched fleece is a composite of Vicryl and PDS which provides strong fixation without the use of sutures. This material is usually absorbable within
- 90 days, with PROLENE* remaining intact to provide long term fixation. A curved stainless steel inserter instrument and “release wire”is attached on both ends to the mesh. The prosthetic implant is placed under the midurethra and is fixed in the “hammock” position into the obturator internus muscle. In the “U” tape position it is attached behind the pubic bone to the connective tissue of urogenital diaphragm.
Results. High effectiveness of the method was observed post-operatively. The period of follow-up has been relatively short. 10 women were observed. Complete cure was obtained in 9 patients (90%), improvement in 1 (10%).The procedure was well-tolerated by all patients, with no significant intra- or post-operative complications observed. Urinary bladder was not injured while the device guiding the tape was being inserted behind the pubic bone. Urine retention after micturition was observed in two women, which regressed completely after 5 days and the symptoms of urgency were reduced within 4 weeks after the procedure, were noted in 1 case. Special attention should be paid to the patients with recurrent incontinence, in which 100% cure rate was obtained in patients previously treated by gynaecologists with other (non-sling type) surgical methods.
Conclusions. The obtained results allow to conclude that the TVT Secur method in the treatment of SUI is a mini-invasive, relatively safe and effective procedure in the treatment of SUI, even in case of recurrences. Short period of hospitalization allows to reduce convalescence time and favors quicker recovery. However, objective assessment of the method would require a longer period of post-operative follow-up.