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MONOFILAMENT VERSUS MULTIFILAMENT POLYPROPYLENE MESH FOR FEMALE INCONTINENCE: SAFETY EVALUATION
1133
1134
PER- AND POST-OPERATIVE COMPLICATIONS OF TVT (TENSION-
SIGNIFICANT COMPLICATIONS FOLLOWING URETHRAL TAPE IMPLANTATION: A NEGLECTED PROBLEM
FREE VAGINAL TAPE): OUR EXPERIENCE Fotas A.1, Charalambous S.1, Fatles G.1, Papathanasiou A.1, Touloupidis S.2, Rombis V.1 1
Ippokrateio Hospital, Dept. of Urology, Thessalonica, Greece, 2University Hospital
of Alexandroupolis, Dept. of Urology, Alexandroupolis, Greece INTRODUCTION & OBJECTIVES: The object of the presentation is to demonstrate the incidence of complications associated with the tension-free vaginal tape (TVT) procedure. MATERIAL & METHODS: A total of 274 women, 38-81 years (mean age: 58,1 years) underwent TVT procedure for the treatment of stress urinary incontinence the last 5 years in our department. Follow-up evaluation included questionnaire assessments, physical examination with a stress test, uroflowmetry and post void residual urine measurement. The follow-up period ranged from 6 months to 5 years. RESULTS: Bladder perforations were noted in 26 patients (9.4%). 27 patients (10%) had post void residual urine around 100 ml and 2 failed to void reaching complete retention which was managed by cutting the tape. 14 patients underwent urethral dilatations and have showed resolution of the voiding symptoms. In 2 cases vaginal erosion took place due to vaginal infection and finally in one patient a pelvic haematoma took place and had to be treated with an open surgical operation. CONCLUSIONS: The tension-free vaginal procedure is a safe, minimal invasive technique for the treatment of female urinary stress incontinence. Although life threatening complications have been described they are extremely rare and do not decrease the value of the procedure. Despite the rather high incidence of complications, (total of 21.6%) most of them are minor with a limited morbidity and they usually have no consequences.
Klingler H.C., Tinzl M., Marberger M. Medical University of Vienna, of Urology, Vienna, Austria INTRODUCTION & OBJECTIVES: Significant complications following urethral tape surgery in treatment of stress urinary incontinence (SUI) are rarely documented. We report on a single centre experience with such complications following various forms of urethral tape surgery. MATERIAL & METHODS: Between 4/2000 and 8/2005 16 women and 1 man were referred to our institution due to significant complications (massive haemorrhage 5, urethral tape arosion 5, chronic urinary retention 7) following urethral tape surgery. Surgical technique employed was TVT in 14, antegrade sling in 1 and tape of unknown manufacturer in 1 woman, additionally male sling in 1 man. One procedure was performed at our institution; all other interventions were performed in other hospitals. 8/17 interventions were performed as day case surgery. All techniques were standard surgical cases and recommended surgical guidelines were followed in all cases. In 15/17 (77%) interventions the performing surgeon was even considered to be an expert. Pre-operatively 12/17 patients had SUI II° and 2/17 SUI III°, wearing mean 4.1 (range 3-7) pads daily. However, in 4/17 patients none of recommended urodynamic investigations were performed prior to surgery, including 3/17 patients with a weak indication for incontinence surgery – suffering from mild symptoms of SUI I°, using mean 1.3 (range 1-2) pads daily. RESULTS: Massive haemorrhage required poly-transfusion of mean 6.1 (range 5-11) blood units and open surgical intervention with transfer to intensive care, followed by long-term rehabilitation in all cases. Cause of bleeding was arterial in 2 and venous in 3 cases. In all patients tapes were removed and a Burch colposuspension was performed. 3/5 patients are dry, 2 improved to SUI I°. All patients with tape arosion presented with recurrent urinary tract infection, residual volume and persistent urinary leakage. In all patients transvaginal urethroplasty after tape removal was performed. No urinary fistula occurred. 3 patients have persisting SUI I° but refuse further intervention, one SUI II° patient required fascial sling intervention. All patients with chronic urinary retention are on permanent single catheterisation, in 5/7 patients no urodynamic or cystoscopic obstruction could be documented. Not surprisingly tape incision in 4 patients did not improve voiding function. The patient with male sling received immediate AMS sphincter after sling removal. CONCLUSIONS: Significant complications may occur with urethral tapes, even with state-of the art technique in the hands of experts and these complications are nor rare. Consequently, urethra tapes cannot be regarded as minimal invasive or day case interventions. Likewise, recommended evaluation of patients considered for incontinence surgery must be strictly followed.
1135
1136
VOIDING DYSFUNCTION FOLLOWING TRANSOBTURATOR TAPE PROCEDURE
MONOFILAMENT VERSUS MULTIFILAMENT POLYPROPYLENE MESH FOR FEMALE INCONTINENCE: SAFETY EVALUATION
Sivanesan K., Abdel Fattah M., Ramsay I.
Martinez Sagarra J.M.1, Garcia-Tuñon C.2, Castroviejo Rodriguez-Toves A.1, Amon Sesmero J.H.1, Conde Redondo C.1
South Glasgow University Hospitals, Urogynaecology, Glasgow, United Kingdom INTRODUCTION & OBJECTIVES: Transobturator tape(TOT) is emerging as one of the minimally invasive procedure for female urinary stress incontinence. It avoids entry into retropubic space, thus avoiding injury to bladder, intestines and major blood vessels. Since it is relatively new procedure, we focussed on voiding dysfunction following TOT. MATERIAL & METHODS: We carried out a retrospective study of 149 patients who had undergone TOT between June 2003 to may 2005 for urodynamically proven urinary stress incontinence. The case notes were reviewed to collect the data on the period of catherisation, duration and management. RESULTS: mean age is 51 years (26-87). 109 patients had urinary stress incontinence while 41 had mixed incontinence. Majority of procedures were carried out under general anaesthetic while only one patient had local anaesthetic. Postoperatively none of the patients had indwelling catheter. mean operating time was 16.4 minutes (12-27). one patient had urethral injury. Bladder injury was diagnosed in one patient 4 weeks postoperatively. ‘satisfactory voiding’ is achieved when voided volume is > 200 mls & post voiding residual volume is < 100 mls. If satisfactory voiding not achieved, patients are taught double voiding and they continue with conservative management. The criteria for abandoning conservative management in favour for catheterisation are: complete urinary retention, post voiding residual volume > 250 mls on two occasions and unsatisfactory voiding for 24 hours. Incidence of post operative voiding dysfunction is 14.76 (22/149). None of the patients had complete urinary retention. 11 patients only had temporary voiding dysfunction which improved with conservative a mangement. 10 patients required catheterisation. out of 10 patients, six patients had indwelling catheter for only up to 24 hours. In one patient catheter was removed successfully after one week. In 3 patients, catheter remained up to 3 weeks. They required clean self intermittent catheterisation (CISC) and now being followed up by multidisciplinary team. Interestingly, one patient had initial successful voiding. She presented six weeks later with unsatisfactory voiding pattern. She required division of tape under general anaesthesia. She now suffers from mild stress urinary incontinence. CONCLUSIONS: Voiding dysfunction following TOT is common and patients have to be counselled properly pre-operatively. majority of them could be managed with conservative measures and catheterisation for short term.
Eur Urol Suppl 2006;5(2):306
Royo
F.1,
Hospital Rio Hortega, Urology, Valladolid, Spain, 2Hospital Rio Hortega, Gynaecology, Valladolid, Spain
1
INTRODUCTION & OBJECTIVES: With the recent increased awareness in female urology a multitude of techniques to treat stress incontinence and pelvic floor reconstruction has been developed using synthetic mesh devices. Recently, it has been advocate that silicone-coated mesh should be avoided because polypropylene mesh allows better tissue ingrowths. The aim of this study is to compare two different polypropylene meshes: monofilament versus multifilament in order to know which of them has the less extrusion and infection rate. MATERIAL & METHODS: We prospectively treated 104 patients with surgical treatment for urinary incontinence with or without cystocele. Patients have been divided in two groups. Group A: 77 treated with monofilament polypropylene mesh; 42 TVT (Tension Less Vaginal Tape, Ethicon, New Brunswick, New Jersey), 27 MOARC (American Medical System , Minneapolis, Minnesota) and 8 SPARC (American Medical System, Minneapolis, Minnesota). Group B: 28 patients treated with multifilament polypropylene mesh; IVS tunneller (Tyco Health care group). The review was performed to retrieve data on safety and efficacy using meshes. Results were treated with Student T Test. RESULTS: There were no statistically differences between groups in continence rate. Extrusion and infection rate for monofilament polypropylene group was 0%, and 14.28% for multifilament group manifested as defected vaginal healing. Mean time to presenting symptoms was 9 months (range 2 to 15). All patients required surgical exploration, drainage of the collection and removal of the tape bilaterally. Transvaginal extraction was unexpectedly easy because multifilament mesh was covered by a tissue reaction forming a pseudo capsule. CONCLUSIONS: Multifilament polypropylene meshes appear to be more at risk of infection and extrusion than monofilament polypropylene ones. It may be relates to pore size of the mesh which allows the integration of the mesh in the surrounding tissue.
1134
PER- AND POST-OPERATIVE COMPLICATIONS OF TVT (TENSION-
SIGNIFICANT COMPLICATIONS FOLLOWING URETHRAL TAPE IMPLANTATION: A NEGLECTED PROBLEM
FREE VAGINAL TAPE): OUR EXPERIENCE Fotas A.1, Charalambous S.1, Fatles G.1, Papathanasiou A.1, Touloupidis S.2, Rombis V.1 1
Ippokrateio Hospital, Dept. of Urology, Thessalonica, Greece, 2University Hospital
of Alexandroupolis, Dept. of Urology, Alexandroupolis, Greece INTRODUCTION & OBJECTIVES: The object of the presentation is to demonstrate the incidence of complications associated with the tension-free vaginal tape (TVT) procedure. MATERIAL & METHODS: A total of 274 women, 38-81 years (mean age: 58,1 years) underwent TVT procedure for the treatment of stress urinary incontinence the last 5 years in our department. Follow-up evaluation included questionnaire assessments, physical examination with a stress test, uroflowmetry and post void residual urine measurement. The follow-up period ranged from 6 months to 5 years. RESULTS: Bladder perforations were noted in 26 patients (9.4%). 27 patients (10%) had post void residual urine around 100 ml and 2 failed to void reaching complete retention which was managed by cutting the tape. 14 patients underwent urethral dilatations and have showed resolution of the voiding symptoms. In 2 cases vaginal erosion took place due to vaginal infection and finally in one patient a pelvic haematoma took place and had to be treated with an open surgical operation. CONCLUSIONS: The tension-free vaginal procedure is a safe, minimal invasive technique for the treatment of female urinary stress incontinence. Although life threatening complications have been described they are extremely rare and do not decrease the value of the procedure. Despite the rather high incidence of complications, (total of 21.6%) most of them are minor with a limited morbidity and they usually have no consequences.
Klingler H.C., Tinzl M., Marberger M. Medical University of Vienna, of Urology, Vienna, Austria INTRODUCTION & OBJECTIVES: Significant complications following urethral tape surgery in treatment of stress urinary incontinence (SUI) are rarely documented. We report on a single centre experience with such complications following various forms of urethral tape surgery. MATERIAL & METHODS: Between 4/2000 and 8/2005 16 women and 1 man were referred to our institution due to significant complications (massive haemorrhage 5, urethral tape arosion 5, chronic urinary retention 7) following urethral tape surgery. Surgical technique employed was TVT in 14, antegrade sling in 1 and tape of unknown manufacturer in 1 woman, additionally male sling in 1 man. One procedure was performed at our institution; all other interventions were performed in other hospitals. 8/17 interventions were performed as day case surgery. All techniques were standard surgical cases and recommended surgical guidelines were followed in all cases. In 15/17 (77%) interventions the performing surgeon was even considered to be an expert. Pre-operatively 12/17 patients had SUI II° and 2/17 SUI III°, wearing mean 4.1 (range 3-7) pads daily. However, in 4/17 patients none of recommended urodynamic investigations were performed prior to surgery, including 3/17 patients with a weak indication for incontinence surgery – suffering from mild symptoms of SUI I°, using mean 1.3 (range 1-2) pads daily. RESULTS: Massive haemorrhage required poly-transfusion of mean 6.1 (range 5-11) blood units and open surgical intervention with transfer to intensive care, followed by long-term rehabilitation in all cases. Cause of bleeding was arterial in 2 and venous in 3 cases. In all patients tapes were removed and a Burch colposuspension was performed. 3/5 patients are dry, 2 improved to SUI I°. All patients with tape arosion presented with recurrent urinary tract infection, residual volume and persistent urinary leakage. In all patients transvaginal urethroplasty after tape removal was performed. No urinary fistula occurred. 3 patients have persisting SUI I° but refuse further intervention, one SUI II° patient required fascial sling intervention. All patients with chronic urinary retention are on permanent single catheterisation, in 5/7 patients no urodynamic or cystoscopic obstruction could be documented. Not surprisingly tape incision in 4 patients did not improve voiding function. The patient with male sling received immediate AMS sphincter after sling removal. CONCLUSIONS: Significant complications may occur with urethral tapes, even with state-of the art technique in the hands of experts and these complications are nor rare. Consequently, urethra tapes cannot be regarded as minimal invasive or day case interventions. Likewise, recommended evaluation of patients considered for incontinence surgery must be strictly followed.
1135
1136
VOIDING DYSFUNCTION FOLLOWING TRANSOBTURATOR TAPE PROCEDURE
MONOFILAMENT VERSUS MULTIFILAMENT POLYPROPYLENE MESH FOR FEMALE INCONTINENCE: SAFETY EVALUATION
Sivanesan K., Abdel Fattah M., Ramsay I.
Martinez Sagarra J.M.1, Garcia-Tuñon C.2, Castroviejo Rodriguez-Toves A.1, Amon Sesmero J.H.1, Conde Redondo C.1
South Glasgow University Hospitals, Urogynaecology, Glasgow, United Kingdom INTRODUCTION & OBJECTIVES: Transobturator tape(TOT) is emerging as one of the minimally invasive procedure for female urinary stress incontinence. It avoids entry into retropubic space, thus avoiding injury to bladder, intestines and major blood vessels. Since it is relatively new procedure, we focussed on voiding dysfunction following TOT. MATERIAL & METHODS: We carried out a retrospective study of 149 patients who had undergone TOT between June 2003 to may 2005 for urodynamically proven urinary stress incontinence. The case notes were reviewed to collect the data on the period of catherisation, duration and management. RESULTS: mean age is 51 years (26-87). 109 patients had urinary stress incontinence while 41 had mixed incontinence. Majority of procedures were carried out under general anaesthetic while only one patient had local anaesthetic. Postoperatively none of the patients had indwelling catheter. mean operating time was 16.4 minutes (12-27). one patient had urethral injury. Bladder injury was diagnosed in one patient 4 weeks postoperatively. ‘satisfactory voiding’ is achieved when voided volume is > 200 mls & post voiding residual volume is < 100 mls. If satisfactory voiding not achieved, patients are taught double voiding and they continue with conservative management. The criteria for abandoning conservative management in favour for catheterisation are: complete urinary retention, post voiding residual volume > 250 mls on two occasions and unsatisfactory voiding for 24 hours. Incidence of post operative voiding dysfunction is 14.76 (22/149). None of the patients had complete urinary retention. 11 patients only had temporary voiding dysfunction which improved with conservative a mangement. 10 patients required catheterisation. out of 10 patients, six patients had indwelling catheter for only up to 24 hours. In one patient catheter was removed successfully after one week. In 3 patients, catheter remained up to 3 weeks. They required clean self intermittent catheterisation (CISC) and now being followed up by multidisciplinary team. Interestingly, one patient had initial successful voiding. She presented six weeks later with unsatisfactory voiding pattern. She required division of tape under general anaesthesia. She now suffers from mild stress urinary incontinence. CONCLUSIONS: Voiding dysfunction following TOT is common and patients have to be counselled properly pre-operatively. majority of them could be managed with conservative measures and catheterisation for short term.
Eur Urol Suppl 2006;5(2):306
Royo
F.1,
Hospital Rio Hortega, Urology, Valladolid, Spain, 2Hospital Rio Hortega, Gynaecology, Valladolid, Spain
1
INTRODUCTION & OBJECTIVES: With the recent increased awareness in female urology a multitude of techniques to treat stress incontinence and pelvic floor reconstruction has been developed using synthetic mesh devices. Recently, it has been advocate that silicone-coated mesh should be avoided because polypropylene mesh allows better tissue ingrowths. The aim of this study is to compare two different polypropylene meshes: monofilament versus multifilament in order to know which of them has the less extrusion and infection rate. MATERIAL & METHODS: We prospectively treated 104 patients with surgical treatment for urinary incontinence with or without cystocele. Patients have been divided in two groups. Group A: 77 treated with monofilament polypropylene mesh; 42 TVT (Tension Less Vaginal Tape, Ethicon, New Brunswick, New Jersey), 27 MOARC (American Medical System , Minneapolis, Minnesota) and 8 SPARC (American Medical System, Minneapolis, Minnesota). Group B: 28 patients treated with multifilament polypropylene mesh; IVS tunneller (Tyco Health care group). The review was performed to retrieve data on safety and efficacy using meshes. Results were treated with Student T Test. RESULTS: There were no statistically differences between groups in continence rate. Extrusion and infection rate for monofilament polypropylene group was 0%, and 14.28% for multifilament group manifested as defected vaginal healing. Mean time to presenting symptoms was 9 months (range 2 to 15). All patients required surgical exploration, drainage of the collection and removal of the tape bilaterally. Transvaginal extraction was unexpectedly easy because multifilament mesh was covered by a tissue reaction forming a pseudo capsule. CONCLUSIONS: Multifilament polypropylene meshes appear to be more at risk of infection and extrusion than monofilament polypropylene ones. It may be relates to pore size of the mesh which allows the integration of the mesh in the surrounding tissue.