Tags

Type your tag names separated by a space and hit enter

Tension-free vaginal tape and percutaneous vaginal tape sling procedures.
Tech Urol. 2001 Jun; 7(2):90-100.TU

Abstract

PURPOSE

Midurethral synthetic sling procedures for treatment of stress urinary incontinence (SUI) are gaining increased attention from surgeons specializing in female pelvic reconstructive techniques seeking successful patient outcomes through reproducible simplicity. This report describes the procedural steps and methods used to maximize the potential for successful outcomes using techniques of midurethral synthetic sling placement. Reported complications and surgical outcomes are reviewed with respect to patient selection and minimizing the potential for morbidity and mortality as long-term clinical experience is accumulated.

MATERIALS AND METHODS

Tension-free vaginal or transvaginal tape (TVT) and the recently introduced percutaneous vaginal tape (PVT) are two new procedural choices for placement of synthetic sling material at the midurethra. Both procedures use sling material composed of polypropylene mesh, a nonabsorbable synthetic material, placed at the level of the midurethra via an antegrade (PVT, using a percutaneous ligature carrier) suprapubic approach or retrograde (TVT, using vaginal trocars) vaginal approach. Patient selection, procedural techniques, and methods described are based on observations obtained or reported from clinical experience. Outcomes and complications for TVT are derived from a literature review of all published articles in Index Medicus from 1996 to 2000.

RESULTS

The experience with TVT for the last 5 years is encouraging. At 3-year follow-up for TVT, reported cure rates for SUI range from 80% to 95%. A multitude of worldwide reports on PVT with shorter follow-up support the findings of the TVT experience. Reproducible findings with midurethral synthetic slings are the short operative times recorded for the sling procedure, ease of technical performance, minimal patient discomfort, and a high rate of early return of normal voiding function. The rate of complications such as obstructive voiding or de novo instability (0-15%) and urinary retention necessitating a secondary procedure (2-4%) appear to be equal to the rates of contemporary competing technologies and procedures for treatment of SUI.

CONCLUSIONS

Preliminary reports and the experience at our institution suggest that the techniques of midurethral synthetic sling placement of TVT and PVT are reproducible, easy to master, and minimally invasive with respect to tissue handling. Although complications with all anti-incontinence procedures exist, understanding the anatomical considerations and methodology of these unique procedures should minimize patient morbidity, avoid patient mortality, and produce a high rate of durable success.

Authors+Show Affiliations

Section of Voiding Dysfunction and Female Urology, Urological Institute, Cleveland Clinic Foundation, Ohio 44195, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11384000

Citation

Rackley, R R., et al. "Tension-free Vaginal Tape and Percutaneous Vaginal Tape Sling Procedures." Techniques in Urology, vol. 7, no. 2, 2001, pp. 90-100.
Rackley RR, Abdelmalak JB, Tchetgen MB, et al. Tension-free vaginal tape and percutaneous vaginal tape sling procedures. Tech Urol. 2001;7(2):90-100.
Rackley, R. R., Abdelmalak, J. B., Tchetgen, M. B., Madjar, S., Jones, S., & Noble, M. (2001). Tension-free vaginal tape and percutaneous vaginal tape sling procedures. Techniques in Urology, 7(2), 90-100.
Rackley RR, et al. Tension-free Vaginal Tape and Percutaneous Vaginal Tape Sling Procedures. Tech Urol. 2001;7(2):90-100. PubMed PMID: 11384000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tension-free vaginal tape and percutaneous vaginal tape sling procedures. AU - Rackley,R R, AU - Abdelmalak,J B, AU - Tchetgen,M B, AU - Madjar,S, AU - Jones,S, AU - Noble,M, PY - 2001/6/1/pubmed PY - 2001/10/12/medline PY - 2001/6/1/entrez SP - 90 EP - 100 JF - Techniques in urology JO - Tech Urol VL - 7 IS - 2 N2 - PURPOSE: Midurethral synthetic sling procedures for treatment of stress urinary incontinence (SUI) are gaining increased attention from surgeons specializing in female pelvic reconstructive techniques seeking successful patient outcomes through reproducible simplicity. This report describes the procedural steps and methods used to maximize the potential for successful outcomes using techniques of midurethral synthetic sling placement. Reported complications and surgical outcomes are reviewed with respect to patient selection and minimizing the potential for morbidity and mortality as long-term clinical experience is accumulated. MATERIALS AND METHODS: Tension-free vaginal or transvaginal tape (TVT) and the recently introduced percutaneous vaginal tape (PVT) are two new procedural choices for placement of synthetic sling material at the midurethra. Both procedures use sling material composed of polypropylene mesh, a nonabsorbable synthetic material, placed at the level of the midurethra via an antegrade (PVT, using a percutaneous ligature carrier) suprapubic approach or retrograde (TVT, using vaginal trocars) vaginal approach. Patient selection, procedural techniques, and methods described are based on observations obtained or reported from clinical experience. Outcomes and complications for TVT are derived from a literature review of all published articles in Index Medicus from 1996 to 2000. RESULTS: The experience with TVT for the last 5 years is encouraging. At 3-year follow-up for TVT, reported cure rates for SUI range from 80% to 95%. A multitude of worldwide reports on PVT with shorter follow-up support the findings of the TVT experience. Reproducible findings with midurethral synthetic slings are the short operative times recorded for the sling procedure, ease of technical performance, minimal patient discomfort, and a high rate of early return of normal voiding function. The rate of complications such as obstructive voiding or de novo instability (0-15%) and urinary retention necessitating a secondary procedure (2-4%) appear to be equal to the rates of contemporary competing technologies and procedures for treatment of SUI. CONCLUSIONS: Preliminary reports and the experience at our institution suggest that the techniques of midurethral synthetic sling placement of TVT and PVT are reproducible, easy to master, and minimally invasive with respect to tissue handling. Although complications with all anti-incontinence procedures exist, understanding the anatomical considerations and methodology of these unique procedures should minimize patient morbidity, avoid patient mortality, and produce a high rate of durable success. SN - 1079-3259 UR - https://www.unboundmedicine.com/medline/citation/11384000/Tension_free_vaginal_tape_and_percutaneous_vaginal_tape_sling_procedures_ L2 - https://medlineplus.gov/pelvicfloordisorders.html DB - PRIME DP - Unbound Medicine ER -