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New surgical technique for treatment of stress urinary incontinence TVT-ABBREVO from development to clinical experience.
Surg Technol Int. 2012 Dec; 22:149-57.ST

Abstract

Tension-free suburethral tapes have revolutionized the surgical treatment of female stress urinary incontinence (SUI). These tapes are inserted by way of a retropubic or transobturator route. The inside-out tension-free vaginal tape transobturator approach, or TVT-Obturator system (TVT-O, Ethicon Women's Health and Urology, Somerville, NJ), was developed ten years ago with the aim of minimizing the risk of urinary tract injuries associated with retropubic and outside-in transobturator tapes while reproducibly ensuring minimal tissue dissection. Cadaveric studies have shown that the anatomical trajectory of the TVT-O tape is strictly perineal and courses away from neighboring obturator and pudendal neurovascular structures. Several meta-analyses have shown similar SUI cure rates after retropubic and transobturator tape procedures. Yet, the transobturator route may be associated with less voiding dysfunction, blood loss, bladder perforation, and shorter operating time. The original TVT-O procedure was modified with the aim of reducing the incidence of postoperative groin pain as well as the rather theoretical risk of obturator nerve injury. This modified procedure, named TVT-ABBREVO (Ethicon Women's Health and Urology, Somerville, NJ), utilizes a shortened, 12-cm-long polypropylene tape. In addition, perforation of the obturator membrane with the scissors and guide is avoided in order to reduce the depth of lateral dissection, and consequently, to maximize securing of the tape within the obturator muscular/aponeurotic structures. In a comparative anatomical study, it was indeed observed that the shorter tape traversed less muscular structures (with no or only a minimal amount of tape lying in the adductor muscles) than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal. In a single-center randomized clinical trial, after a 3-year minimum follow-up, the modified TVT-O procedure with a shorter tape and reduced dissection was found to be as safe and efficient as the primal procedure for treating female SUI, with less severe and frequent groin pain in the immediate postoperative period.

Authors+Show Affiliations

Department of Urology, University Hospital of Liège, Liège, Belgium.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23109075

Citation

Waltregny, David, and Jean de Leval. "New Surgical Technique for Treatment of Stress Urinary Incontinence TVT-ABBREVO From Development to Clinical Experience." Surgical Technology International, vol. 22, 2012, pp. 149-57.
Waltregny D, de Leval J. New surgical technique for treatment of stress urinary incontinence TVT-ABBREVO from development to clinical experience. Surg Technol Int. 2012;22:149-57.
Waltregny, D., & de Leval, J. (2012). New surgical technique for treatment of stress urinary incontinence TVT-ABBREVO from development to clinical experience. Surgical Technology International, 22, 149-57.
Waltregny D, de Leval J. New Surgical Technique for Treatment of Stress Urinary Incontinence TVT-ABBREVO From Development to Clinical Experience. Surg Technol Int. 2012;22:149-57. PubMed PMID: 23109075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New surgical technique for treatment of stress urinary incontinence TVT-ABBREVO from development to clinical experience. AU - Waltregny,David, AU - de Leval,Jean, PY - 2012/10/31/entrez PY - 2012/10/31/pubmed PY - 2013/12/18/medline SP - 149 EP - 57 JF - Surgical technology international JO - Surg Technol Int VL - 22 N2 - Tension-free suburethral tapes have revolutionized the surgical treatment of female stress urinary incontinence (SUI). These tapes are inserted by way of a retropubic or transobturator route. The inside-out tension-free vaginal tape transobturator approach, or TVT-Obturator system (TVT-O, Ethicon Women's Health and Urology, Somerville, NJ), was developed ten years ago with the aim of minimizing the risk of urinary tract injuries associated with retropubic and outside-in transobturator tapes while reproducibly ensuring minimal tissue dissection. Cadaveric studies have shown that the anatomical trajectory of the TVT-O tape is strictly perineal and courses away from neighboring obturator and pudendal neurovascular structures. Several meta-analyses have shown similar SUI cure rates after retropubic and transobturator tape procedures. Yet, the transobturator route may be associated with less voiding dysfunction, blood loss, bladder perforation, and shorter operating time. The original TVT-O procedure was modified with the aim of reducing the incidence of postoperative groin pain as well as the rather theoretical risk of obturator nerve injury. This modified procedure, named TVT-ABBREVO (Ethicon Women's Health and Urology, Somerville, NJ), utilizes a shortened, 12-cm-long polypropylene tape. In addition, perforation of the obturator membrane with the scissors and guide is avoided in order to reduce the depth of lateral dissection, and consequently, to maximize securing of the tape within the obturator muscular/aponeurotic structures. In a comparative anatomical study, it was indeed observed that the shorter tape traversed less muscular structures (with no or only a minimal amount of tape lying in the adductor muscles) than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal. In a single-center randomized clinical trial, after a 3-year minimum follow-up, the modified TVT-O procedure with a shorter tape and reduced dissection was found to be as safe and efficient as the primal procedure for treating female SUI, with less severe and frequent groin pain in the immediate postoperative period. SN - 1090-3941 UR - https://www.unboundmedicine.com/medline/citation/23109075/New_surgical_technique_for_treatment_of_stress_urinary_incontinence_TVT_ABBREVO_from_development_to_clinical_experience_ L2 - http://surgicaltechnology.com/22-Gynecology.htm#149 DB - PRIME DP - Unbound Medicine ER -